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How to Code Heart Failure in ICD-10

• Kathy LeBeau

How to Code Heart Failure in ICD-10


Updated guidelines from the Coding Clinic have clarified coding Heart Failure with more specificity in regards to documented diastolic or systolic dysfunction. 

  • When the physician links diastolic or systolic dysfunction with heart failure, it is coded as diastolic or systolic heart failure. 
  • If the physician does not link the two conditions, a relationship cannot be assumed and the two conditions should be coded separately. 
  • If the patient has hypertension and diastolic or systolic dysfunction, there is an assumed relationship between these two conditions.
  • There is also an assumed relationship between hypertension and heart failure.  

**Let’s look at some examples of how a physician may document these conditions and the specific coding combinations that would be use to report these conditions**



Scenario:

Mrs. Smith a 60 y/o female patient has been admitted to Home Health for weight checks and needs education for monitoring edema in regards to her Congestive Heart Failure with Systolic Dysfunction. The order also includes instruction to monitor and log blood pressure, as she has newly been diagnosed with Hypertension. She is Oxygen Dependent because of her COPD. How would you code for M1021/M1023?

 

In this scenario, the MD connects the systolic dysfunction with the heart failure, so it is coded as systolic heart failure. There is also an assumed relationship between the hypertension and heart failure. Reporting this accurately requires the two codes, I11.0 and I50.20. The COPD and dependence on oxygen are added as co-morbidities. 

 

Kathy LeBeau, RN, BSN, HCS-D, COS-C

Coding & OASIS Review Specialist

Our coding and OASIS review specialist, Kathy, joined our team of expert coders in 2014. Her experience as an RN at Ocean Springs Hospital in the surgical, oncology and telemetry units shines brightly, as Kathy’s knowledge and skills help home health agencies conquer tough coding challenges.