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This month's issue of the CCHIS Newsletter discusses coding Heart Failure in ICD-9 CM and ICD-10 CM.
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Simplistically speaking, heart failure is the heart’s inability to pump enough blood needed to sustain the body. Blood carries two essential gases oxygen and carbon dioxide. The lungs exchange these two essential gases in the blood. Oxygen enters the blood from the lungs and carbon dioxide is expelled out of the blood into the lungs. See the diagram.
It is easy to see why shortness of breath is one of the key
symptoms of heart failure along with fatigue and swelling in the ankles, feet, legs, abdomen, and veins in the neck. In some instances, the heart cannot fill with enough blood (diastolic). While in other cases, the heart cannot pump blood to the rest of the body with enough force (systolic). Other common names include congestive heart failure, left-side heart failure, right-side heart failure, and cor pulmonale caused by hypertension in the pulmonary arteries and right ventricle. Heart failure can affect both children and adults; complicate a pregnancy, an abortion, a delivery; be hypertensive and rheumatic or be the result of a postoperative encounter. For the purposes of this article, we will be discussing heart failure of a non-hypertensive, non-rheumatic, non-obstetric adult. Follow the link, http://youtu.be/JA0Wb3gc4mE, to get an idea of “How a Normal Heart Pumps Blood.”
WHAT IS HEART FAILURE?
WHAT TO EXPECT
1 What is Heart Failure?
2 How Should Heart Failure
be Coded?
3 Coding Scenario
4 Requests for Coding Topics
“Heart failure is the
heart’s inability to
pump enough blood.”
June 2014
Volume 1 Issue 6
By Cynthia Brown, MBA, RHIT, CCS
www.cyntcodinghealthinformationservices.com
CCHIS, P.O. Box 3019, Decatur, GA 30031 404-992-8984 http://www.cyntcodinghealth informationserv ices.com Cynth ia@cyntcodinghealthinformat ionserv ices.com [phone ]
CODING YESTERDAY’S NOMENCLATURE TODAY®
Coding Heart Failure in ICD-9 CM & ICD-10 CM
CODING NEWSLETTER FOR HEALTHCARE
CODING PROFESSIONALS
Page 2 Coding Yesterday’s Nomenclature Today
In ICD-9 CM, the Heart Failure codes begin with 428.0 and end with 428.9. In ICD-10 CM, the codes range between I50.1 through I50.9. Let’s look at the coding guidelines:
Acute and Chronic Heart Failure: 428.9 (ICD-9) and I50.9 (ICD-10). Coding Clinic, November-December 1985, page 14.
Acute Pulmonary Edema/CHF: 428.1 (ICD-9) and I50.1 (ICD-10). Coding Clinic, 3rd Quarter, 1988, page 3.
Systolic Heart Failure: 428.20-428.23 (ICD-9) and I50.20-I50.23. Coding Clinic, 4th Quarter, 2004, page 140. Note: CHF is not an inherent component of systolic heart failure; add the code for CHF (428.0) if documentation supports. In ICD-10, congestive is a nonessential modifier and if present an additional diagnosis code is not required. See full explanation about nonessential modifiers below.
Diastolic Heart Failure: 428.30-428.33 (ICD-9) and I50.30-I50.33. Coding Clinic, 4th Quarter, 2004, page 140. Note: CHF is not an inherent component of diastolic heart failure; add the code for CHF (428.0) if documentation supports. In ICD-10, congestive is a nonessential modifier and if present an additional diagnosis code is not required. See full explanation about nonessential modifiers below.
Combined Systolic and Diastolic CHF: 428.40-428.43 and 428.0 (ICD-9) and I50.40-I50.43 (ICD-10). Coding Clinic, 4th Quarter, 2002, pages 52 and 53. Note: In the code descriptions for ICD-10 congestive is enclosed in parentheses. In ICD-10 CM, parentheses are used in both the Alphabetic Index and Tabular List to enclose supplementary words that may be present or absent in the statement of a disease without affecting the code number to which it is assigned (ICD-10 CM Training Manual, 2014). In this case congestive is a non-essential modifier; therefore the requirement of a code for congestive heart failure as in ICD-9 is not necessary.
Congestive Heart Failure, Unspecified: 428.0 (ICD-9) and I50.9 (ICD-10).
www.cyntcodinghealthinformationservices.com
“Healthy Heart”
“Non-essential
Modifiers are used in
ICD-10 CM to include
congestive.”
HOW SHOULD HEART FAILURE BE CODED?
Coding Yesterday’s Nomenclature Today
The patient was admitted in acute and chronic systolic/diastolic congestive heart failure. The patient is status post aortic valve replacement and currently has severe mitral valve regurgitation, systolic and diastolic dysfunction, tricuspid valve regurgitation and a history of aortic valve stenosis status post valve replacement. How should this be coded?
Answer: Assign code 428.43 (ICD-9), Combined systolic and
diastolic heart failure, Acute or chronic, as the principal diagnosis or I50.43 (ICD-10). As stated in Coding Clinic Second Quarter 2000, pages 16-17, "Do not make an assumption that the congestive heart failure is rheumatic in nature. Unless ICD-9-CM directs the coder to assign the code for "rheumatic," it is inappropriate to assign a code for rheumatic congestive heart failure." Assign codes 428.0, Congestive heart failure, unspecified (ICD-9) CODE FOR CONGESTIVE HEART FAILURE IS NOT NECESSARY IN ICD-10; 424.0, Mitral valve disorders (ICD-9) or I34.8 (ICD-10); 397.0, Diseases of tricuspid valve (ICD-9) or I07.8 (ICD-10); and V43.3, Organ or tissue replaced by other means, heart valve (ICD-9) or Z95.2 (ICD-10), as additional diagnoses. Code 397.0 is the default in ICD-9 CM, when the cause of the tricuspid valve regurgitation is not specified. This advice is consistent with that published in Coding Clinic Second Quarter 2000, page 16. Cynthia Brown, MBA, RHIT, CCS AHIMA Approved ICD-10 CM/PCS Trainer CyntCoding Health Information Services Phone: 404-992-8984/E-Fax: 678-805-4919 P.O. Box 3019 Decatur, GA 30031 [email protected] www.cyntcodinghealthinformationservices.com http://cyntcodinghealthinformationservices.blogspot.com Coding Yesterday’s Nomenclature Today®
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Page 4 Coding Yesterday’s Nomenclature Today
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