ED Coding and Reimbursement Alert

Question: What are some signs and symptoms that a patient might have had heart failure?


Kentucky Subscriber


Answer: Because heart failure means that body tissues aren't receiving adequate oxygenation or fluid removal, the patient will present with common telltale signs of trouble:

- Shortness of breath--Also called dyspnea, use 786.05 (Shortness of breath).

- Fatigue--Also called asthenia or lethargy, report 780.79 (Other malaise and fatigue).

- Edema--As a general symptom without a heart failure diagnosis, report edema as 782.3 (Edema).

- Cough producing bloody sputum--Edema in the lungs can result in bloody sputum, which you can report as 786.3 (Hemoptysis).

- Rapid heart rate--The heart may race in an effort to do its job. As a symptom with no further diagnosis, report 785.0 (Tachycardia, unspecified).

Your physician's notes may indicate some of the above symptoms, but if he also diagnoses heart failure, you should choose an additional ICD-9 code for the patient's condition. Here is a brief look at different types of heart failure and their corresponding ICD-9 codes:

- Left ventricular heart failure--Also called left ventricular dilation, you should code this condition as 428.1 (Left heart failure).

- Right ventricular heart failure--Also called congestive heart failure, you should report this condition as 428.0 (Congestive heart failure, unspecified).

- Systolic heart failure--You should report this type of heart failure as 428.2x (Systolic heart failure). Add a fifth digit to the code to indicate if the condition is acute, chronic, acute following chronic, or unspecified.

- Diastolic heart failure--Use 428.3x (Diastolic heart failure) to report this condition. Add a fifth digit to the code to indicate if the condition is acute, chronic, acute following chronic, or unspecified.

- Combined systolic and diastolic heart failure--ICD-9 provides 428.4x (Combined systolic and diastolic heart failure) for combined systolic/diastolic heart failure. As with diastolic and systolic failure, report combined failure to the fifth digit.

- Other heart failure--If the physician does not specify the type of failure, but indicates -weak heart- or -myocardial failure,- report 428.9 (Heart failure, unspecified). Decompensated heart failure is a rapid onset of heart failure over days or months. Report the condition as 428.0.