Radiology Coding Alert

Question: The indication documents the patient as having hypertensive heart disease with acute systolic congestive heart failure. Which codes I should I report and in which order I should report them?

Oregon Subscriber

Answer: On your claim, you should first report code I11.0 (Hypertensive heart disease with heart failure) followed by code I50.21 (Acute systolic (congestive) heart failure).

If you look under code I11.0 in the ICD-10-CM manual, you will find a coding note that tells you to “use an additional code to identify type of heart failure (I50.-).” In this case the patient has acute systolic congestive heart failure, so I50.21 identifies that condition. You should report I11.0 first because that’s what ICD-10-CM instructs you to do.

Don’t miss: The ICD-10 CM Official Guidelines state the causal relationship between hypertension and heart involvement is assumed because the conditions are linked by the term “with” in the Alphabetic Index. So, even if the provider does not state the cause-and-effect relationship in his documentation you should assign the combination code. The same assumed causal relationship applies when the documentation states the patient has hypertension and kidney disease.