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The Topic:

Heart Failure with Preserved Ejection Fraction and Heart Failure with Reduced Ejection Fraction

ICD-10-CM-

Question

Please reconsider the advice previously published in Coding Clinic, First Quarter 2014, page 25, stating that the coder cannot assume either diastolic or systolic failure or a combination of both, based on documentation of heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF). Would it be appropriate to code diastolic or systolic heart failure when the provider documents HFpEF or HFrEF?

 

Answer

Based on additional information received from the American College of Cardiology (ACC), the Editorial Advisory Board for Coding Clinic for ICD- 10-CM/PCS has reconsidered previously published advice about coding heart failure with preserved ejection fraction (HFpEF), and heart failure with reduced ejection fraction (HFrEF). HFpEF may also be referred to as heart failure with preserved systolic function, and this condition may also be referred to as diastolic heart failure. HFrEF may also be called heart failure with low ejection fraction, or heart failure with reduced systolic function, or other similar terms meaning systolic heart failure. These terms HFpEF and HFrEF are more contemporary terms that are being more frequently used, and can be further described as acute or chronic.

Rationale

Therefore, when the provider has documented HFpEF, HFrEF, or other similar terms noted above, the coder may interpret these as "diastolic heart failure" or "systolic heart failure," respectively, or a combination of both if indicated, and assign the appropriate ICD-10-CM codes

 

ICD-10-PCS-

Question

A patient diagnosed with hypoplastic left heart syndrome, status post Norwood procedure and bidirectional Glenn procedure, presents for Fontan completion stage II. The intent of the procedure is to connect the inferior vena cava with the right pulmonary artery via a prosthetic conduit. What is the appropriate ICD-10-PCS code for this procedure?

Answer

02160JQ    Bypass right atrium to right pulmonary artery with synthetic substitute, open approach

Rationale

Although there are various methods to complete the Fontan procedure, ultimately the procedure is performed for blood flow to bypass the right ventricle and the blood to pass from the right atrium to the pulmonary artery.

Reference:  Coding Clinic, First Quarter ICD-10 2016 Pages: 10-11 Effective with discharges: March 18, 2016


  One of the best (and maybe worst) things about the coding profession is that there is always so much more to learn. The infinite nuances of various continuously changing coding guidelines combined with the wildcard variable of documentation, and evolving HIM technology give us no choice but to take the “never stop learning” philosophy especially seriously. Whether you are one of our coders or not, HCCS is here to help you in your pursuit of knowledge as you grow in your career. Through the Coding Canapés series of posts, we’ll regularly introduce and interpret official guidelines such as AHA’s Coding Clinic. We hope coders everywhere benefit from and even enjoy these posts. Bon Appétit!

Topics: Work From Home, Medical Coding, ICD-10, Coding Canapes, Health Information Management

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(a.k.a. HCCS)

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