Guest Post: New ICD-10-CM/PCS codes up the ante in coding compliance, part 3: Right heart failure

by James S. Kennedy, MD, CCS, CDIP

Editor’s note: With the fiscal year 2018 ICD-10-CM/PCS codes released, Kennedy unpacked some of the compliance pitfalls and opportunities awaiting CDI and coding professionals when these new codes are implemented on October 1. Some of these issues may be addressed in the 2018 ICD-10-CM Official Guidelines for Coding and Reporting or the American Hospital Association’s Coding Clinic, Fourth Quarter, 2017, so be sure to compare Kennedy’s opinions with these documents. This article is part three in a three-part series. Click here to read parts one and two!

Right Heart Failure

Notice that we now have new codes for acute, chronic, and acute-on-chronic right heart failure. Remember also that Coding Clinic, Third Quarter, 2013, p. 33, states that the documented term of “decompensated” indicates that there has been a flare-up (acute phase) of a chronic condition.

These are great codes; however, we must remember that the right heart failure codes should only apply when there is no left heart failure. As such, should you see the terms “systolic” or “diastolic” in the setting of isolated right heart failure, you may not want to assign a code for I50.2-I50.43 since the codes for “systolic” or “diastolic” only apply to LEFT heart failure, not RIGHT heart failure. My support for this reasoning is the “code also” note under code I50.82 (biventricular heart failure) that states to code the type of LEFT ventricular failure as systolic, diastolic, or combined, if known (I50.2-I50.43).  Therefore, no code for I50.81- should coexist with I50.2-I50.43.

I encourage you to review the new ICD-10-CM codes and their addenda for yourself. When released on the CMS website in August, be sure to read the 2018 IPPS final rule which will describe the CC/MCC status of these codes. I’d love to hear of your thoughts and experiences with the issues.

Editor’s note: This article originally appeared in BCCS. Dr. Kennedy is a general internist and certified coder, specializing in clinical effectiveness, medical informatics, and clinical documentation and coding improvement strategies. Contact him at 615-479-7021 or at jkennedy@cdimd.com. Advice given is general. Readers should consult professional counsel for specific legal, ethical, clinical, or coding questions.