Congestive heart failure (CHF) can now automatically be linked with hypertension according to Coding Clinic 1st Quarter 2017, Hypertension with Congestive Heart Failure, page 47.  Previously, hypertension had a presumed link with chronic kidney disease only. This Coding Clinic advice is as follows:

Question:

In the guideline for hypertension with heart disease, category I50, Heart Failure, is included in the list of heart conditions that are classified as hypertensive heart disease, but it is not included in the Alphabetic Index nor the Tabular List. Is congestive heart failure (CHF) in a patient with hypertension coded as hypertensive heart disease with failure, when the provider’s documentation has not explicitly linked the two conditions?

Answer:

Assign code I10.0, Hypertensive heart disease, with failure, along with the appropriate code from category I50, Heart failure, for CHF in a patient with hypertension. The classification presumes a causal relationship between hypertension and heart involvement unless the provider documents that the conditions are unrelated.

Although heart failure is not in the list of heart conditions in the inclusion note, in ICD-10-CM, there is a note instructing “Use additional code to identify type of heart failure” in the Tabula List. The code range under category I11, Hypertensive heart failure, is not intended to be an all-inclusive list. The range of heart conditions in the Alphabetic Index and Tabular List will be considered for future modification through the Coordination and Maintenance Committee.

Additionally, Coding Clinic 1st Quarter 2016, states heart failure with preserved ejection fraction (HFpEF) may be interpreted as diastolic heart failure. Heart failure with reduced ejection fraction (HFrEF) may be interpreted as systolic heart failure. Therefore, when the provider has documented HFpEF, HFrEF, or similar terms, the coder may interpret these as “diastolic heart failure” or “systolic heart failure” respectively, or a combination of both if indicated and assign the appropriate ICD-10-CM codes. (Correction to this Coding Clinic: Coding Clinic 3rd Quarter 2016, page 46).

References:

  • AHA Coding Clinic, First Quarter 2017, page 47
  • AHA Coding Clinic, First Quarter 2016, page 10
  • AHA Coding Clinic, Third Quarter 2016, page 46

By Barb Brant, MPA RN CDIP CCDS CCS