Heart failure is the heart's inability to pump enough blood to sustain the body. It occurs when the heart cannot fill with enough blood (diastolic heart failure) or cannot pump blood with enough force (systolic heart failure). Common symptoms include shortness of breath, fatigue, and swelling. Heart failure can have various causes and affects both children and adults. It is important to accurately code heart failure in medical records.

1. 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.cyntcodinghealthinformationservices.com
Cynthia@cyntcodinghealthinformationservices.com [phone]
CODING YESTERDAY’S NOMENCLATURE TODAY®
Coding Heart Failure in ICD-9 CM & ICD-10 CM
CODING NEWSLETTER FOR HEALTHCARE
CODING PROFESSIONALS

2. 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?

3. 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
cyntcoder@cyntcodinghealthinformationservices.com
www.cyntcodinghealthinformationservices.com
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Coding Yesterday’s Nomenclature Today®
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