Are you looking for CHF ICD 10 & 11 Codes? This article includes all the medical codes you will need to report CHF (Congestive Heart Failure), as well as other related specific ICD 10 codes such as Exacerbation and Diastolic CHF. Read on for a summary of the necessary ICD 10 & 11 codes followed by a further description.
What Is CHF (Congestive Heart Failure)?
Congestive heart failure often referred to as Heart failure is a condition in which a heart is unable to pump enough blood because of damaged or weakened power muscles. CHF is a chronic condition in which fluid accumulates around the heart walls and heart muscles lack the power to pump the blood in respective directions.
Around 7 million people in the United States are hospitalized each year because of this condition and most of them are old age patients. It is a life-threatening condition and immediate treatment should be provided to affected patients. Mainly two types of heart failure are;
- Diastolic CHF: When the heart has a problem with the relaxation of muscles to allow the blood entrance into ventricles for proper pumping.
- Systolic CHF: Reduction of the heart’s ability to contract, unable to pump the blood to other body organs, one of most common types of CHF.
CHF ICD 10
The CHF ICD 10 code is I50.9. Searching for the ICD 10 CM Code for congestive heart failure should start from the main term “Failure’ in the alphabetic index and then find “Heart” under in, which will lead to category I50 (heart failure). This code category in the tabular index should be verified and choose the appropriate code according to the description.
Before selecting a code, coding instructions like Code also, Code first, Exclude 1, and Exclude 2 should be consulted. These instructions are present under both categories, subcategories, and complete codes.
ICD 10 & 11 Codes For CHF
This article covers the following ICD 10 & 11 codes for CHF:
CHF ICD 10 Codes
- ICD 10 CM I50 – Heart failure
- ICD 10 CM I50.9 – Heart failure, unspecified
- ICD 10 CM Z86.79 – Personal history of other diseases of the circulatory system
- ICD 10 CM I50.89 – Other heart failure
- ICD 10 CM E87 – Other disorders of fluid, electrolyte and acid-base balance
- ICD 10 CM I50.3 – Diastolic (congestive) heart failure
- ICD 10 CM I50.33 – Acute on chronic diastolic (congestive) heart failure
- ICD 10 CM I50.4 – Combined systolic (congestive) and diastolic (congestive) heart failure
- ICD 10 CM I50.43 – Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
- ICD 10 CM I50.2 – Systolic (congestive) heart failure
- ICD 10 CM I50.23 – Acute on chronic systolic (congestive) heart failure
- ICD 10 CM I50.30 – Unspecified diastolic (congestive) heart failure
- ICD 10 CM I50.31 – Acute diastolic (congestive) heart failure
- ICD 10 CM I50.20 – Unspecified systolic (congestive) heart failure
- ICD 10 CM I50.22 – Chronic systolic (congestive) heart failure
- ICD 10 CM I50.21 – Acute systolic (congestive) heart failure
- ICD 10 CM I11 – Hypertensive heart disease
- ICD 10 CM I11.0 – Hypertensive heart disease with heart failure
- ICD 10 CM I11.9 – Hypertensive heart disease without heart failure
CHF ICD 11 Codes
The CHF ICD 11 code(s) are as follows:
- ICD 11 XT5R – Acute
- ICD 11 XT8W – Chronic
- ICD 11 BD10 – Heart failure
ICD 10 CHF Unspecified
The ICD 10 CHF Unspecified code is I50.9. If a document contains only “heart failure” as a confirmed medical condition of the patient, Code selection, according to CMS guidelines, will be I50.9.
As the terms “heart failure” and “congestive heart failure” are used interchangeably, I50.9 should be used for both conditions if only have that much information. Under I50.9, there is a description of diagnoses that fall under this code like a myocardial failure, etc.
ICD 10 Code For History Of CHF
The ICD 10 code For History Of CHF is Z86.79. History of medical condition can be defined as a condition that was present before and now is resolved or no more treatment is needed for that specific condition. Locating the main term “history” in the alphabetic index and then finding failure/heart will direct to use Z86.79 (personal history of other diseases of the circulatory system) for the history of CHF.
It means there is no specified code available for the history of CHF; instead, it’s covered under the history of other cardiovascular problems.
ICD 11 Code For CHF
Searching congestive heart failure in the alphabetic index of the ICD-11 coding tool provided by WHO, numerous codes related to heart failure containing the term “congestive” would pop up. The choice of category is “BD10” and under the main category, there is a list of extension codes that should be used to fully describe the condition.
Using more than one stem code with extension codes is called cluster-coding, watch out for those extension codes for a selection of severity and course. The ICD 11 code for CHF is BD10.
How To Code CHF Exacerbation
The following information is specifically written to help you decide how to code CHF exacerbation.
What Is CHF Exacerbation?
Exacerbation simply means the worsening of the condition, If an already damaged heart is exposed to excessive salt intake, improper medications, or inappropriate workout, It can lead to worsening of problem that is called exacerbation of heart failure. CHF exacerbation is one of the most sought medical emergency treatments in the US as of now.
Coding CHF Exacerbation With ICD 10
Unfortunately, exacerbation of CHF does not have a specified code available to use in the ICD-10-CM system, Following ICD-10 guidelines, the code selection will be I50.9. There is an argument of using “I50.89; other specified heart failures” for exacerbation that is understandable but following official guidelines from the alphabetic-tabular index will always lead to I50.9. The ICD 10 code for CHF exacerbation is I50.9.
Acute CHF Exacerbation ICD 10 Code
The Acute CHF Exacerbation ICD 10 code is I50.9. “Congestive heart failure NOS” is the same code that should be used for both “acute” and “chronic” exacerbated heart failure, there are no separate guidelines available for that purpose.
ICD 10 Code For CHF Exacerbation With Fluid Overload
The ICD 10 Code For CHF Exacerbation With Fluid Overload is I50.9.
According to the CHF definition, fluid overload is one of the key components of Heart failure, normally it is coded in the E87 ICD 10 category but there is no need to code fluid overload separately. In this case, only I50.9 should be used as exacerbation as well as a fluid overload will fall under this code definition.
Sending the E87 category with I50 may deny your claim with “unacceptable bundled diagnosis”.
CHF Exacerbation ICD 11 Code
The CHF Exacerbation ICD 11 code is BD10.
Unfortunately, ICD 11 coding system also has not provided a separate code of exacerbated conditions of heart failure. According to different sources, there may be an exception in future updates of ICD-11 but currently, “BD10” with extension codes should be used to show if the condition is chronic/acute or any other extension that is needed to describe the severity.
How To Code Acute On Chronic CHF
The following information is specifically written to help you decide how to code acute on chronic CHF.
What Is Acute On Chronic CHF?
When heart muscles are damaged chronically, the term “Chronic” is used to define such a condition but sometimes, a chronically damaged heart can get a viral infection, certain vessels blockage, or shortness of breath leading to “acute” heart failure of chronic CHF. Medical professionals call it “acute on chronic heart failure”. The simple definition could be “Sudden onset of chronic heart condition”.
Acute On Chronic CHF ICD 10
The Acute On Chronic CHF ICD 10 code is I50.89. In the ICD 10 coding system, acute on chronic CHF have a separate list of codes but only if systolic, diastolic, or literality is mentioned like if the condition exists on the right side or left side. If the severity of literality is not mentioned, the Code of choice should be I50.9 or more appropriately I50.89 as other specified heart failures.
Acute on chronic does fall “not elsewhere classified” category as the condition is specified more accurately by the doctor but there is no existence of specific code in that case.
Acute On Chronic Diastolic CHF ICD 10
The Acute On Chronic Diastolic CHF ICD 10 code is I50.33.
When looking at “diastolic” under failure/heart in the alphabetic index, the ICD 10 system provides subcategory I50.3 for diastolic heart failure. Under this category, several codes according to different specified descriptions are provided; I50.33 at the bottom of this subcategory is the code of choice to fully describe the condition “acute on chronic diastolic heart failure”.
Acute On Chronic Combined Systolic And Diastolic CHF ICD 10
The acute on chronic combined systolic and diastolic CHF ICD 10 code is I50.43.
A combined condition of systolic and diastolic CHF is not a very common but dangerous condition. In this abnormal situation, a heart neither contract nor relax properly between beats leading to a serious medical condition. If a medical note states that the patient has acute on chronic with combined diastolic and systolic heart failure, ICD-10 has provided a combination code to fully describe this condition.
The main term “combined” after following failure/heart in the alphabetic index will lead to subcategory I50.4. The combination code for reimbursement purposes is I50.43.
Acute On Chronic Systolic CHF ICD 10
The Acute On Chronic Systolic CHF ICD 10 code is I50.23.
ICD 10 has a different subcategory of codes for both systolic and diastolic heart failures, I50.2 for systolic, and I50.3 for diastolic heart failure. If the diagnosis is described as only “systolic” but acute and chronic, the code, under this subcategory I50.23, is complete code for this condition. If the provider has not mentioned systolic or diastolic, never use code from the I50.3 or I50.2 category.
Acute On Chronic CHF ICD 11
The Acute On Chronic CHF ICD 11 codes are BD10 and XT5R/XT8W.
Currently, there is no combination code available to describe acute on chronic diastolic heart failure. The main stem code (same as a category in ICD-10) BD10 is used with either acute XT5R or chronic XT8W as available extension codes.
Other extensions for severity and type of heart failure with complexity are available to extend the diagnosis code in ICD-11 but the main stem code is the same for all conditions related to congestive heart failure.
How To Code Diastolic CHF
The following information is specifically written to help you decide how to code diastolic CHF.
What Is Diastolic CHF?
Diastolic heart failure occurs when a heart is unable to relax fully, making ventricles deprived of enough blood to pump the blood to other organs. The volume and pumping force decreases significantly making the heart as well as other body areas deprived of oxygenated blood significantly. Doctors use different medications as well as surgical options to treat this condition.
Diastolic CHF ICD 10 Code
The diastolic CHF ICD 10 code is I50.30. The subcategory for diastolic heart failure is I50.3; should only use this category for a further selection of codes whenever a condition is mentioned as “Diastolic”. If a medical note states that the condition is diastolic but does not mention its severity as chronic or acute, use the first code “unspecified diastolic heart failure” I50.30 for reimbursement purposes.
Chronic Diastolic CHF ICD 10
Chronic CHF has the same subcategory to find the right code for this description. I50.33 is the second last code of this subcategory that states “Chronic diastolic heart failure is most appropriately describing this condition.
According to CMS guidelines, verifying each code in the tabular index of CPT code and/or using a coding tool, there must be a complete description against each code with matching keywords and synonyms. The ICD 10 code for chronic CHF diastolic is I50.33.
Acute Diastolic CHF ICD 10
When improper relaxation becomes an emergency condition, a doctor calls it an acute diastolic condition. The first code under the main subcategory, I50.31 is the most appropriate code for this condition.
If the provider has described the condition as an acute one, a coder cannot self-analyze the condition even if the treatment is described as an emergency one in medical notes. The ICD 10 code for acute CHF diastolic is I50.31.
Acute Exacerbation Of Diastolic CHF ICD 10
The Acute Exacerbation Of Diastolic CHF ICD 10 code is I50.30. Exacerbation does not have a specific code entry either in the diastolic subcategory, for this reason, the code only for acute diastolic CHF is used to describe the condition unless there is the description of acute on chronic heart failure. The code of choice under this category is I50.31.
Diastolic CHF ICD 11 Code
The Diastolic CHF ICD 11 Code is BD10. ICD 11 does not have category and subcategory but these terms are named as stem code and extensions respectively. The main stem code is the same just like the category in ICD-10; “BD10” there is no code for exacerbation.
There are some extensions about types of heart failure that are divided based on code rules of ICD-11 like if there is an effect on physical activity or not and others. Currently, BD10 with an acute extension should be used to code this condition.
How To Code Systolic CHF
The following information is specifically written to help you decide how to code systolic CHF.
What Is Systolic CHF?
When left muscles and walls of the left ventricle become weak, not generating enough power to pump the blood to other body organs or contraction of the heart is not enough to produce normal blood flow; it is called systolic heart failure or more appropriately systolic CHF.
Systolic CHF ICD 10
The Systolic CHF ICD 10 code is I50.20. Looking at the alphabetic index as failure/heart and then systolic, It will lead to subcategory I50.2 “Systolic heart failure. The first code I50.20 is the best code when no more details are provided apart from “systolic”. ICD 10 system instructs to use unspecified code when there is a code, that is more appropriate, available but there is a lack of details from a medical provider.
Chronic Systolic CHF ICD 10
The Chronic Systolic CHF ICD 10 code is I50.22. The third code in this category as “chronic systolic heart failure” I50.22 is the code of choice here. The main code has excluded notes beneath it that states that a code cannot be used here if there is a combination of the acute and chronic condition of systolic/diastolic heart failure.
Acute Systolic CHF ICD 10
If the patient’s condition is acute, the second code under this subcategory should be used for reimbursement purposes. If the medical note states that the patient’s condition has been worsening or there is an emergency condition of chronic failure but does not document it as acute, do not presume it as an acute condition.
A query to the medical doctor would work here best asking about the exact condition. The ICD 10 code for acute systolic CHF is I50.21.
Systolic CHF ICD 11
After selecting the main stem code “BD10”, the second step would be choosing the severity from the second extension code. There is no current official use of ICD 11 in the US, WHO has only provided the codes and conventions only for worldwide usage. US modifications will need time to come into effect. The ICD 11 code for systolic CHF is BD10.
How To Code HTN With CHF
The following information is specifically written to help you decide how to code HTN with CHF.
What Is HTN With CHF?
Hypertension can be defined as chronic high blood pressure, causes can be environmental or genetics but it mostly leads to heart failure in most patients. The most important effect of hypertension is on the left ventricle making it weak and causing hypertrophy of the ventricle. Whenever HTN becomes the developmental factor of CHF, it’s called hypertensive heart disease.
HTN With CHF ICD 10 Code
HTN with CHF are two conditions, there is a combined category for this co-existing term “I11”. There are only codes in this category, I11.0, and I11.9. According to the ICD 10 system, hypertensive heart disease is either with I11.0 or without heart failure I11.9.
Whenever a medical note states hypertension and heart failure, a coder should assume a causal relationship between these two conditions and choose the code I11.0 in that case. There is an instruction to choose a code from category I50 to specify the types of heart failure.
For example, if simply hypertension with heart failure is mentioned, the ICD 10 code for HTN with CHF is I11.0 and I50.9 as no other details about heart failure have been provided.
HTN With CHF ICD 11
The HTN With CHF ICD 11 code is BA01. The main stem code for this condition is hypertension, type “hypertension” in ICD-11 coding tool by WHO, a stem category of “hypertensive heart disease” with “BA01” can be found that is main stem code for this condition. Choose another manifestation code for “heart failure” under the main stem code to complete the coding.