Cardiology Coding Alert
6 Tips Guide Streamline Your Heart Failure ICD-10-CM Claims
Always read the “code first” notes. Tip 1: Understand What Heart Failure Is If your cardiologist treats patients for heart failure in your practice, you should understand what that patient is experiencing. It’s a common myth that when a patient has heart failure, his heart stops beating, but that is not actually the case. Instead, when a patient has heart failure, his heart will still continue to beat. However, his heart will not pump blood adequately to meet his body’s need for blood and oxygen. This is turn can cause blood and fluids to back up in the patient’s body in his lungs, hands, or feet. Tip 2: Don’t Miss These Heart Failure Scales “Often times the provider will list a classification from one of two scales to indicate the severity or stage of heart failure,” says Robin Peterson, CPC, CPMA, Manager of Professional Coding, Pinnacle Integrated Coding Solutions, LLC. “These scales are from either the New York Heart Association (NYHA) or the American College of Cardiology (ACC)/American Heart Association (AHA).” NYHA scale: The NYHA has a symptom-based scale and the patient will be put into one of the four categories based on their symptoms, according to Peterson. Class 1 – The patient doesn’t experience any symptoms at any time. Class 2 – The patient can perform daily activities with ease but feels fatigued or winded when they exert themselves. Class 3 – The patient has difficulties completing daily activities. Class 4 – The patient feels short of breath, even at rest. ACC/AHA scale: The ACC/AHA scale is a stage-based system, per Peterson. Stage A – The patient has one or more risk factors for heart failure, but they aren’t experiencing any symptoms. Stage B – The patient has heart disease but doesn’t have any signs or symptoms of heart failure. Stage C – The patient has heart disease and is experiencing signs or symptoms of heart failure. Stage D – The patient has advanced heart failure that requires specialized treatments. “As always, query your provider if the documentation is unclear or if you are uncertain about whether the patient is having an acute episode of heart failure,” Peterson adds. Tip 3: File These Heart Failure Acronyms Away If you see the abbreviations HFrEF or HFpEF in your cardiologist’s medical documentation, you should know these are abbreviations for heart failure. For example, HFrEF is 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 his heart is not able to contract normally, so his heart can’t pump with enough force to push enough blood into circulation. On the other hand, HFpEF is the acronym for heart failure with preserved ejection fraction, also called diastolic failure. When a patient suffers from diastolic heart failure, the muscle of the 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. Tip 4: Rely on These Codes for Systolic Heart Failure If you look under category I50.2- (Systolic (congestive) heart failure), you will notice this code also include heart failure with reduced ejection fraction (HFrEF) and systolic left ventricular heart failure. You should report the following ICD-10-CM codes for systolic congestive heart failure: Tip 5: Turn to These Codes for Diastolic Heart Failure If your cardiologist documents diastolic congestive heart failure, you should turn to category I50.3- (Diastolic (congestive) heart failure). Here are your code choices: Don’t miss: Under category I50.3-, 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). Tip 6: Heed “Code First” Notes When it comes to reporting the I50- ICD-10-CM codes, you always want to make sure to read the “code first” notes. 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.” So, when you look in the tabular list under category I50-, you discover this “code first” note tells you to sequence the following underlying conditions first, followed by the appropriate code from I50- to identify the specific type of heart failure: Coding example: A patient has postprocedural heart failure following cardiac surgery. The cardiologist documents the patient’s heart failure as acute systolic congestive. You should report I97.130, I50.21 (Acute systolic (congestive) heart failure).
Cardiology Coding Alert
- CCI 27.0:
Target 2021 Congenital Transcatheter and Ventricular Assist Device CCI Edits for Coding Success
Make sure you know what the different modifier indicators mean. You’ve learned all about the [...] - ICD-10-CM:
6 Tips Guide Streamline Your Heart Failure ICD-10-CM Claims
Always read the “code first” notes. Tip 1: Understand What Heart Failure Is If your [...] - COVID-19:
Observe Pros and Cons of Mandatory Versus Optional COVID-19 Vaccines for Employees
Use your flu vaccine policies as a blueprint. Now that a COVID-19 vaccination is available, [...] - You Be the Coder:
Decipher This Procainamide Infusion Study Scenario
Question: Can you please help me with this scenario? I’m looking at code +93623, but [...] - Reader Questions:
Learn How to Verify Medicare Patient’s Eligibility With Electronic Claim Form
Question: We’re trying to verify a Medicare beneficiary’s eligibility with our MAC using an electronic [...] - Reader Questions:
Dig Into This 6-Lead ECG Home Visit Situation
Question: Can you help me find the correct code for a 6-lead ECG home visit? [...] - Reader Questions:
Understand Device Interrogation Billing Guidelines
Question: Can you please help me understand the requirements for billing device interrogations in the [...] - Reader Questions:
Grasp Definition of Medical Necessity
Question: I am new to coding. Can you help define medical necessity for me? Oregon [...] - Reader Questions:
Be Aware of ICD-11
Question: I listened in on a webinar recently where the speaker said to prepare now [...]
