My provider has listed I50.21 & I50.22 in his progress note. Would this automatically be considered acute on chronic and should be reported with I50.23 or can the patient have both acute and chronic and I50.21 & I50.22 would be appropriate? If so what is the difference and does the provider need to specify something in the note to clearly indicate if it is acute on chronic or if they have both? I cannot seem to find clarification on if its always acute on chronic when both are being reported or if the patient can have both reported with individual codes.