ICD-10 Documentation Criteria: Congestive Heart Failure - Mercy Medical Center

ICD-10 Documentation Criteria: Congestive Heart Failure

Posted on: June 21, 2016

Heart failure is defined as impairment of diastolic filling or of systolic ejection of blood that results from functional or structural abnormalities of the heart. Systolic (EF below normal <55%) and diastolic with normal or elevated EF (Normal EF 55-70% and elevated >70%).

Signs and Symptoms of CHF:

  • Shortness of breath
  • Persistent coughing or wheezing
  • Build-up of excess fluid in body tissue
  • Tiredness, fatigue
  • Lack of appetite
  • Confusion, impaired thinking
  • Increased heart rate
  • Indicators of acute heart failure
  • Exacerbation of symptoms
  • IV medications (usually Lasix)
  • Supplemental oxygen
  • Pulmonary edema/congestion or increasing (or new) pleural effusion on chest x-ray 
  • BNP>500 or ProBNP >3,000 (if no renal impairment)

For ICD-10 coding of Heart Failure, the following can be used to document the different types:

  1. Preserved ejection fraction (HFpEF) – also referred to as diastolic heart failure.
  2. Reduced ejection fraction (HFrEF) – also referred to as systolic heart failure.
  3. Preserved/reduced (HFpEF, HFrEF) – also referred to as combinations of both.

Please note that the acuity still needs to be documented.

Example: Patient presented with SOB, LE edema with diagnosis of acute CHF, echo revealed a reduced ejection fraction of 35%. This will be coded as cuite systolic CHF. 



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