Cardiology Coding Alert

Reader Question:

Turn to These ICD-10 Codes for Systolic Congestive Heart Failure

Question: A patient presented with dyspnea and peripheral edema and said she has had a cough for about two weeks. The physician performed an exam and found that the dyspnea has been happening for several months and is worse on exertion. The physician ordered an ECG and chest X-ray, as well as brain natriuretic peptide (BNP) tests. He documented a diagnosis of HFrEF in the documentation, indicating heart failure. Which ICD-10 code should we report?

North Carolina Subscriber

Answer: When the physician writes HFrEF, that’s 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.

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).

If the physician doesn’t have any additional details in the documentation, you should ask for more information to select the right code.