ICD-10 Coding for Congestive Heart Failure – Diagnosis and Management

Hello Everyone and Welcome to our podcast series

This is Natalie Tornese, Senior Solutions Manager at Outsource Strategies International.

I want to take this opportunity to talk to you about Medical Coding for Congestive Heart Failure Diagnosis and Management

Congestive heart failure (CHF) is a common condition affecting more than 6 million Americans. This chronic progressive condition occurs when your heart muscles are unable to pump enough blood as they normally should, resulting in swelling, shortness of breath, and other issues. Often known as “heart failure”, CHF specifically refers to the stage where the heart muscles become too weak or stiff resulting in fluid build-up around the heart which causes it to pump inefficiently. It develops when your ventricles can’t pump enough blood volume to the body. This eventually may result in blood and other fluids to build-up inside your lungs, liver, abdomen and lower body and can be life-threatening. It is not always possible to reverse the complications or conditions that lead to heart failure. However, correct and early administration of treatment modalities can help improve the immediate signs and symptoms of heart failure and help people live longer. Bringing in vital lifestyle changes such as regular exercise, reducing body weight, consuming a healthy diet and maintaining stress can help reduce the severe complications of CHF and ultimately improve the quality of the patient’s life.

CHF does not mean that your heart has completely stopped working. It just needs some extra support to help it work better. Reports suggest that roughly 670,000 people are diagnosed with heart failure each year in the US. The condition can occur at any age and is a leading cause of hospitalization in older people aged 65 and above.

One of the most common types of heart failure is Left-sided CHF which occurs when your left ventricle doesn’t pump blood properly out to your body. As this condition progresses, fluid can build up in your lungs, which makes breathing difficult. There are two kinds of left-sided heart failure –

• Systolic heart failure – occurs when the left ventricle fails to contract normally and
• Diastolic failure, or diastolic dysfunction–which occurs when the muscle in the left ventricle becomes stiff.

Heart failure is often the result of a number of other conditions that damage the heart muscles at the same time including – coronary artery disease, hypertension, cardiomyopathy, valve conditions, arrhythmias, congenital heart disease and other conditions like diabetes, thyroid disease, and obesity. In addition, anemia, excessive alcohol consumption and an overactive thyroid can also lead to this condition.

In most cases, CHF can be ongoing (chronic), or may start suddenly which is acute. The symptoms may at times be mild to severe. It can be constant or come and go. The symptoms may include –

• Dizziness, fatigue, and weakness
• Rapid or irregular heartbeats
• Fluid and water retention
• Congested lungs
• Fainting
• Chest pain that radiates throughout the upper body
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Increased need to urinate at night and
• Lack of appetite and nausea

If you experience any of the above symptoms that may point to a severe heart condition, it is important to seek immediate medical attention. Diagnosis of this heart condition may generally begin with a detailed physical exam which will involve listening to your heart with a stethoscope to detect abnormal heart rhythms, review of previous medical history and immediate symptoms. A Cardiologist will also check for the presence of risk factors such as high blood pressure, coronary artery disease or diabetes. Several diagnostic imaging tests may be ordered such as an ECG, Echocardiogram, Chest X-ray, Cardiac computerized tomography (CT) scan, MRI, Coronary angiogram, Myocardial biopsy, stress test and blood tests (to check for a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP)may be conducted to diagnose the condition.

Treatment modalities for CHF may mainly depend on the underlying causes and symptoms. A combination of medications such as – Angiotensin-converting enzyme (ACE) inhibitors, Beta Blockers, Diuretics, Aldosterone antagonists, and others will be prescribed to treat this condition effectively.

If medications aren’t effective on their own, cardiologists may recommend surgical procedures to treat the underlying problem that led to heart failure. Angioplasty is a common procedure that is done to open up blocked arteries. Other procedures include – Coronary bypass surgery, Heart valve repair or replacement, Implantable cardioverter-defibrillators (ICDs), Cardiac resynchronization therapy (CRT), or biventricular pacing, ventricular assist devices (VADs) and of course a heart transplant.

Cardiologists or other heart specialists who offer specialized treatment for CHF need to be adequately reimbursed for the services rendered to the patients.

I will include a transcript along with this podcast which will assist the appropriate ICD 10 Codes that coincides with the conditions that we talked about.

The risk of congestive heart failure (CHF) may increase due to several factors like genetics, obesity, high blood pressure, diabetes, of course the use of certain medications. But, apart from these risk factors, remember that lifestyle changes and factors may also play a prominent role. Incorporating key lifestyle changes like – maintaining a well-balanced diet, practicing regular exercise, monitoring your body weight and reducing the intake of alcohol, stopping the habit of smoking, reducing stress – all these things can help relieve signs and symptoms of heart failure and at least delay the onset.

The Coding for CHF – Congestive Heart Failure is very, very challenging. That is something to keep in mind as well.

I hope this helps, but always remember that proper documentation as well as a thorough knowledge of pay regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening!