Health Information Management

Q&A: CHF vs. cor pulmonale

CDI Strategies, April 17, 2008

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Q: I have a question regarding congestive heart failure (CHF): Is it related to cor pulmonale?

A: There are two sides of the heart—left and right. The left heart takes from the lungs and delivers to the peripheral arterial circulation. The right heart takes from the peripheral venous circulation and delivers to the lungs.

When a heart becomes diseased, it can impact the left side of the circulation, the right side of the circulation, or both. When the capability of the ventricle on the affected side of the heart cannot deliver what it promises (i.e., enough blood to fulfill the body's needs), it fails. The 428.xx series of ICD-9-CM codes only involves acute or chronic failure of the left ventricle. But the right heart can also fail, either acutely or chronically.

When the left heart fails because of outlet problems (i.e., hypertension or aortic stenosis), it usually hypertrophies and results in chronic diastolic failure. Report code 428.32 in this instance. When the right heart fails because of chronic lung disease, pulmonary artery hypertension, or pulmonic valve stenosis, it hypertrophies and results in chronic diastolic failure of the right ventricle. This is chronic cor pulmonale. We have no way of tracking failure of the right ventricle, regardless of the cause of the disease of the heart muscle, since no specific codes exist to describe this condition. The right ventricle can dilate when it suffers from ischemic disease and will result in chronic systolic failure of the right ventricle, but all we have is chronic cor pulmonale.

When the right ventricle fails acutely (just as when the left ventricle can fail acutely) it is called acute cor pulmonale, but it is actually acute heart failure of the right side of the heart. We have no way of defining if it is acute systolic or acute diastolic failure because no specific codes exist to describe this condition. You can only report right-sided heart failure using two codes—the chronic cor pulmonale code (416.9) and the acute cor pulmonale code (415.0). If a physician documents these diagnoses as "CHF," all you have is code 428.0. Never assign acute left heart failure codes in this instance.

(Robert S. Gold, MD, CEO of DCBA, Inc., in Atlanta, GA, answered this question. Contact Dr. Gold at DCBAInc@cs.com).



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Comments

1 comments on “Q&A: CHF vs. cor pulmonale

Tina Brooks (2/27/2015 at 5:28 AM)
I realize this is an older article but I have not found a definitive answer to the question: Should an acute exacerbation of Chronic Cor Pulmonale (i.e. Right heart failure due to COPD) ever be coded as Acute Cor Pulmonale? I have researched and found articles that say Acute Cor Pulmonale is a dilatation of the right ventricle caused by pulmonary HTN from a PE and chronic is from hypertrophy from chronic pulmonary HTN but what if the chronic condition worsens and is treated in the inpatient setting? Is there any way to capture the increased SOI/ROM besides chronic Cor Pulmonale? Thank you

 

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