Matters of the Heart: FY2018 Code Changes Impacting Heart Failure

C. Matheson CDI, Coding 2 Comments

Heart failure is a serious medical condition that an estimated 5.7 million Americans are diagnosed with.  This is a condition that occurs when the heart muscle cannot pump enough blood and oxygen needed by the body to support the other organs.  According to the Center for Disease Control, the national estimated cost to treat heart failure is nearly $31 billion each year.  As new technology and advancements in treatment progresses, ICD-10-CM and PCS changes can keep up the pace to appropriately categorize and capture accurate disease data. FY2018 ICD-10-CM code changes brought forth an onslaught of new and revised codes.  One diagnosis category to receive updates and new expansion is in Heart Failure.  This brief article will discuss the high level changes impacting heart failure coding.

A new subcategory was created to uniquely identify several different types of heart failure.   I50.8, Other Heart Failure, was created to delineate other very specific cases of heart failure, such as these below:

  • I50.810 Right heart failure, unspecified
  • I50.811 Acute right heart failure
  • I50.812 Chronic right heart failure
  • I50.813 Acute on chronic right heart failure
  • I50.814 Right heart failure due to left heart failure
  • I50.82 Biventricular heart failure
  • I50.83 High Output heart failure
  • I50.84 End Stage heart failure

Pure right heart failure can now be separately identified from unspecified or left heart failure. According to the American Heart Association (AHA) and the American College of Cardiology (ACC), heart failure is classified into stages.  End stage heart failure, which affects approximately 10% of the heart failure population, can now be separately identified via the use of ICD-10-CM code I50.84.  It falls into AHA and ACC stage D.  Another frequent classification for Heart Failure is the New York Health Association (NYHA) functional classifications and end stage heart failure is generally classified as III or IV, depending on limitations in physical activity.  End stage heart failure is important to separately identify as medical resources to treat are extensive and typically other conventional heart failure therapies and management of the patients symptoms no longer work. Use caution when reviewing documentation and coding for heart failure and always reference your coding guidelines and ICD-10-CM coding book for inclusion terms and exclusion notes.

Comments 2

  1. I have a question, please. Where can I get coding advice on 5 mo old child admitted with congenital cardiomyopathy with acute diastolic heart disease. Orthotopic heart transplant on this child using cadaver donor heart. Ans: I coded I42.4, I50.31. Procedure: 02YA0Z0. Are these codes correct? Or would I code I50.31 as principal? Thank you

    1. Hi Bonita- Thanks for reviewing our article. It sounds like from the brief description in your question your principal diagnosis of I42.4 is correct since the primary condition being treated is the congenital cardiomyopathy and the heart is being replaced in order to correct the congenital issue. In order to code I50.31, you would want to clarify that your documentation states acute diastolic heart failure and not just disease.

      Thank-you and let us know if we can assist further.

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