ICD-10-CM: Heart Failure

Congestive heart failure (CHF) is a common heart condition that exists in many patients. In ICD-9-CM coding, this was reported with code 428.0. In ICD-10-CM, if only CHF or congestive heart failure is documented, it would be reported with I50.9 Heart failure, and would not reflect the true extent of the patients’ condition.

For ICD-10-CM coding and reporting, the type of heart failure should be documented:

• Diastolic
• Systolic
• Combined/mixed diastolic/systolic
• Left ventricular

Also, the acuity of the heart failure:

• Acute
• Chronic
• Acute on chronic
• Unspecified

Here the heart failure codes that are available in ICD-10-CM:

I50.1 Left ventricular failure*

I50.20 Unspecified systolic heart failure*

I50.21 Acute systolic heart failure**

I50.22 Chronic systolic heart failure*

I50.23 Acute on chronic systolic heart failure**

I50.30 Unspecified diastolic heart failure*

I50.31 Acute diastolic heart failure**

I50.32 Chronic diastolic heart failure*

I50.33 Acute on chronic diastolic heart failure**

I50.30 Unspecified systolic and diastolic heart failure*

I50.31 Acute systolic and diastolic heart failure**

I50.32 Chronic systolic and diastolic heart failure*

I50.33 Acute on chronic systolic and diastolic heart failure**

I50.40 Unspecified systolic and diastolic heart failure*

I50.41 Acute systolic and diastolic heart failure**

I50.42 Chronic systolic and diastolic heart failure*

I50.43 Acute on chronic systolic and diastolic heart failure**

For inpatient coding, the *indicate that these diagnoses are CCs. The **indicate that these codes are MCCs, which will typically change the DRG. Documentation should state the type and the acuity, as well as any conditions that may have caused the heart failure, such as hypertension, if it is post procedural or if it is during pregnancy. If this is the case, the relationship should be documented and combination codes would be reported, along with the heart failure code. Also, there are clinical indicators that may be used, such as statements such as ‘diastolic dysfunction’ or ‘systolic dysfunction’ that may be used to report the specific types of heart failure, depending on a facility’s policy.

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