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Inpatient FAQ September 2018

Published on 

Tuesday, September 4, 2018

 | RAC Information 
 | FAQ 

Q:

Any time a patient is documented with (acute/chronic) congestive heart failure and diastolic or systolic dysfunction, can this be coded as diastolic or systolic heart failure?


A:

No.  In ICD-10-CM, there is no longer an index for diastolic/systolic dysfunction. The provider must now link the heart failure (acute and/or chronic) with the diastolic or systolic dysfunction. 

Refer to Coding Clinic, First Quarter 2017: Page 46

  • When provider has linked acute/chronic (congestive) heart failure with either diastolic or systolic dysfunction, it should be coded as “acute/chronic” diastolic and/or systolic heart failure.
  • 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
  • I50.30 – Unspecified diastolic (congestive) heart failure
  • I50.31 – Acute diastolic (congestive) heart failure
  • I50.32 – Chronic diastolic (congestive) heart failure
  • I50.33 – Acute on chronic diastolic (congestive) heart failure
  • I50.40 – Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
  • I50.41 – Acute combined systolic (congestive) and diastolic (congestive) heart failure
  • I50.42 – Chronic combined systolic (congestive) and diastolic (congestive) heart failure
  • I50.43 – Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
  • If there is not supporting documentation linking the two conditions by the provider; assign code I50.9, Heart failure, unspecified.
  • In ICD-10-CM, Congestive heart failure is included in the codes for diastolic and systolic heart failure. When documentation lists congestive heart failure along with either diastolic or systolic heart failure, assign a code for the type of heart failure only (diastolic/systolic).

Example:    

  • Congestive heart failure with acute on chronic diastolic heart failure
  • Assign code I50.33 only. Code I50.9 would not be reported in addition.
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This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.