Cardiology Coding Alert


3 FAQs Help You Avoid Making Heart Failure Coding Mistakes

Hint: Make sure you know the meaning of acronyms HFrEF and HFpEF.

More than 6 million Americans suffer from heart failure, according to the American Heart Association. So, odds are you will come across a situation where you need to know the ins and outs of reporting the ICD-10 codes for heart failure.

Get your questions about heart failure answered to protect your cardiology reimbursement.

Editor's note: Stay tuned next month to learn even more about heart failure.

First, Define Heart Failure for Clarity

FAQ 1: I've always thought when a patient has heart failure, his heart stops beating. Is that true?

Answer: No. That is actually not true. When a patient has heart failure, his heart will still beat. However, a heart failure patient's heart does not pump blood adequately to meet his body's need for blood and oxygen.

"Heart failure occurs when the heart can no longer pump blood as it used to," says Carol Hodge, CPC, CDEO, CCC, CEMC, certified medical coder of St. Joseph's Cardiology in Savannah, Georgia. "This can cause blood and fluids to back up in the body such as in the lungs, hands, and feet."

Don't Miss "Code First" Note for Category I50-

FAQ 2: How does the "code first" note under category I50- (Heart failure) relate to the ICD-10 sequencing rules?

Answer: When it comes to understanding sequencing rules, you want to make sure you pay close attention to the "code first" notes that appear in red under code categories like I50-.

Per the ICD-10 Official Guidelines for Coding and Reporting, "'Code first' notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. When there is a "code first note" and an underlying condition is present, the underlying condition should be sequenced first, if known."

When you look in the tabular list under category I50-, you discover that the code first note tells you to sequence the following underlying conditions first, followed by the appropriate code from I50- identifying the specific type of heart failure:

  • O00.0 (Abdominal pregnancy) through O07- (Failed attempted termination of pregnancy)
  • O08- (Complications following ectopic and molar pregnancy)
  • I11.0 (Hypertensive heart disease with heart failure)
  • I13.- (Hypertensive heart and chronic kidney disease)
  • I97.13- (Postprocedural heart failure)
  • O75.4 (Other complications of obstetric surgery and procedures)
  • I09.81 (Rheumatic heart failure).

Example: A patient has hypertensive heart disease with acute systolic congestive heart failure. You would code I11.0, I50.21 (Acute systolic (congestive) heart failure).

Keep Common Heart Failure Acronyms in Mind

FAQ 3: I keep seeing the abbreviations HFrEF and HFpEF in the documentation for heart failure. Can you explain what these terms mean?

Answer: Take a look at two common acronyms you may see in the documentation for heart failure:

  • HFrEF - The acronym for heart failure with reduced ejection fraction, which is also known as systolic heart failure. When a patient has systolic heart failure, the left ventricle of her heart is not able to contract normally, so her heart can't pump with enough force to push enough blood into circulation.
  • HFpEF - The acronym for heart failure with preserved ejection fraction, also called diastolic failure. When a patient suffers from diastolic heart failure, the muscle of her left ventricle has become stiff and won't relax normally. This results in the heart not adequately filling with blood during the resting period between each heartbeat.

Systolic heart failure explained If you look under category I50.2- (Systolic (congestive) heart failure), you will see two included conditions - heart failure with reduced ejection fraction (HFrEF) and systolic left ventricular heart failure. This is where your HFrEF acronym comes into play.

When you are reporting systolic congestive heart failure, look to the following code choices:

  • I50.20 (Unspecified systolic (congestive) heart failure)
  • I50.21 (Acute systolic (congestive) heart failure)
  • I50.22 (Chronic systolic (congestive) heart failure)
  • I50.23 (Acute on chronic systolic (congestive) heart failure).

Diastolic heart failure explained: If you look under category I50.3- (Diastolic (congestive) heart failure), you will see three included conditions - diastolic left ventricular heart failure, heart failure with normal ejection fraction, and heart failure with preserved ejection fraction (HFpEF). Notice that this category includes the HFpEF acronym.

When you are reporting diastolic congestive heart failure, look to the following code choices:

  • I50.30 (Unspecified diastolic (congestive) heart failure)
  • I50.31 (Acute diastolic (congestive) heart failure)
  • I50.32 (Chronic diastolic (congestive) heart failure)
  • I50.33 (Acute on chronic diastolic (congestive) heart failure).