Home Health & Hospice

Inside scoop | Coding congestive heart failure

Homecare Insider, February 15, 2016

Editor’s note: This week’s Insider’s scoop is from the February issue of Homecare DIRECTION. “Coding corner” is a monthly column written by Joan L. Usher, BS, RHIA, ACE, an AHIMA-approved ICD-10-CM trainer and president & CEO of JLU Health Record Systems in Pembroke, Massachusetts. Click here for more information or to subscribe to Homecare DIRECTION.

February makes us think of hearts and valentines, so what better way to celebrate the month than by reviewing the proper coding of congestive heart failure (CHF)?

CHF is a chronic progressive condition where fluid builds up around the heart, causing it to pump inefficiently. There are two types of left-sided heart failure (systolic and diastolic)—the condition could also be a combination of systolic and diastolic failure. Systolic failure is when the left ventricle loses its ability to contract normally, while diastolic failure is when the left ventricle loses its ability to relax normally.

Coders need to be specific in coding the type of CHF (systolic, diastolic, or combined) and the severity (acute, chronic, or acute on chronic). Acute on chronic is also represented by the terms “decompensation” (the functional deterioration of a previously working structure or system) or “exacerbation” (a worsening or flare-up of the disease).

All codes beginning with I50- are case-mix codes for home health. When collecting information on cardiac diagnoses from the referral source or when reviewing the hospital information, be as specific as possible because the terminology utilized affects the final code assignment by the coder; a specific diagnosis also allows for individualized rather than generalized care planning.