Cardiology Coding Alert

You’ll still have fifth digit options to identify acute or chronic.

ICD-9 and ICD-10 take different approaches to reporting congestive heart failure (CHF). Start preparing now so you can make an easy transition to the new codes next year.

ICD-9-CM Codes

·         428.0, Congestive heart failure, unspecified

·         428.1, Left heart failure

·         428.2x, Systolic heart failure

·         428.3x, Diastolic heart failure

·         428.4x, Combined systolic and diastolic heart failure

·         428.9, Heart failure, unspecified

ICD-10-CM Codes

·         I50.1, Left ventricular failure

·         I50.2-, Systolic (congestive) heart failure

·         I50.3-, Diastolic (congestive) heart failure

·         I50.4-, Combined systolic (congestive) and diastolic (congestive) heart failure

·         I50.9, Heart failure, unspecified

5^th character: ICD-9 (428.2x, 428.3, 428.4x) and ICD-10 (I50.2-, I50.3-, I50.4-) have these fifth character options:

0, unspecified

1, acute

2, chronic

3, acute on chronic.

Heart failure is the term used when a patient’s heart doesn’t function sufficiently to pump blood to the rest of the body. As blood returning to the heart gets backed up by the slow flow of blood out of the heart, congestion and swelling may occur in body tissues, and the physician may diagnose congestive heart failure (CHF).

ICD-9 coding rules: ICD-9 offers one code for left heart failure and distinct ranges for systolic, diastolic, and combined systolic and diastolic heart failure. The codes in those ranges differ based on whether the condition is acute, chronic, acute on chronic, or unspecified.

ICD-9 also offers a distinct code for CHF unspecified (428.0) and another code for heart failure unspecified (428.9). An inclusion note under 428.0 indicates it’s appropriate for congestive heart disease and right heart failure, which may be documented as secondary to left heart failure. Under 428.9, an inclusion note specifies that diagnosis is appropriate for cardiac failure NOS, heart failure NOS, myocardial failure NOS, and weak heart.

ICD-10 changes: ICD-10 coding options for left heart failure as well as systolic, diastolic, and combined systolic and diastolic heart failure are almost identical to ICD-9. What is different between ICD-9 and ICD-10 is that ICD-10 doesn’t include a code specific to unspecified CHF. It has only a code for unspecified heart failure (I50.9). That code will be appropriate for:

·         Biventricular (heart) failure NOS

·         Cardiac, heart or myocardial failure NOS

·         Congestive heart disease

·         Congestive heart failure NOS

·         Right ventricular failure (secondary to left heart failure).

Documentation: If your provider’s documentation for heart failure is sufficient to allow you to choose the proper ICD-9 code, it should be sufficient for ICD-10, as well. You will need to watch for additional documentation to comply with instructional notes for the codes, as explained below.

Coder tips: ICD-9’s 428 (Heart failure) range instructs you to “code, if applicable, heart failure due to hypertension first.” It tells you the range excludes certain obstetric diagnoses and rheumatic heart failure.

For I50.-, ICD-10 instead includes many more diagnoses under a “code first” instruction:

·         Heart failure complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8)

·         Heart failure following surgery (I97.13-)

·         Heart failure due to hypertension (I11.0)

·         Heart failure due to hypertension with chronic kidney disease (I13.-)

·         Obstetric surgery and procedures (O75.4)

·         Rheumatic heart failure (I09.81).

ICD-10 also sports an Excludes1 note, which means you should never report the following with an I50 code:

·         Cardiac arrest (I46.-)

·         Neonatal cardiac failure (P29.0).

Remember: CMS has finalized the ICD-10 compliance date of Oct. 1, 2014. When ICD-10 is implemented, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.