Q&A: Clinical requirements to support cardiogenic shock diagnosis
Q: Do vasopressors have to be used to support the diagnosis of cardiogenic shock?
A: Unlike the clinical diagnosis criteria of septic shock, which requires the use of vasopressors, cardiogenic shock does not require the use of vasopressors for a diagnosis.
Defining cardiogenic shock gets a little tough because there is not a uniform definition. When reading various studies or medical texts that analyze cardiogenic shock, one will see that there is some degree of variation when it comes to the definition and clinical requirements.
With that being said, there are commonalities among the definitions, which are as follows:
- Systolic blood pressure: less than or equal to 90 mm Hg for more than or equal to 30 minutes or vasopressor support to maintain SBP of more than 90 mm Hg
- Evidence of end-organ damage
- Altered mental status
- Cool extremities
- Decreased urinary output
- Elevated lactate level
- Hemodynamic criteria
- Cardiac index: less than 2.2 L/min/m2
- Pulmonary capillary wedge pressure: more than 15 mm Hg
Some studies claim that the diastolic blood pressure has to be 90 mm Hg, or less than 90 mm Hg for 30 minutes, or it has to be less than 90 mm Hg, but the clinicians have to use vasopressors to keep it above 90 mm Hg.
Therefore, while vasopressors are often used clinically for cardiogenic shock treatment, because of that “or” in the definitions, it is not a requirement to support the diagnosis. In other words, if the documentation had everything else, but didn’t have vasopressors, that would not rule out cardiogenic shock as a diagnosis.
However, I will say this: if cardiogenic shock has been diagnosed, and vasopressors aren’t being used, coders should look carefully at the documentation, as vasopressors are so often used. But, ultimately, no, vasopressor use is not a critical component of supporting the diagnosis.
Editor’s note: This article originally appeared in JustCoding. This question was answered by Adriane Martin, DO, FACOS, CCDS, vice president of physician services at Enjoin, during the HCPro webinar, “Clarify 2023 ICD-10-PCS Coding for Cardiovascular Disease Treatments.”