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ICD 10 Codes For Congestive Heart Failure

Last modified: Oct 4, 2015.

A Case Where ICD-10 Agrees With ICD-9. Or Is It?

Most ICD-9 to ICD-10 CM conversions are not a simple affair of converting an ICD-9 code to a fully equivalent ICD-10 code, and congestive heart failure is no exception, even though, at fist sight (see table below), things look quite similar:

Heart Failure Coding Comparison
ICD-9-CM ICD-10-CM
428 - Heart failure I50 - Heart failure
428.1 - Left ventricular failure I50.1 - Left ventricular failure
428.2_ - Systolic heart failure I50.2_ - Systolic (congestive) heart failure
428.3_ - Dyastolic heart failure I50.3_ - Dyastolic (congestive) heart failure
428.4_ - combined systolic and diastolic heart failure I50.4_ - Combined systolic (congestive) and diastolic (congestive) heart failure
428.9 - Heart failure, unspecified I50.9 - Heart failure, unspecified

How To Code in ICD-10 For Heart Failure

ICD-10 code for heart failure

Determine the Cause of Heart Failure

One of the most important things you understand, when coding for heart failure, is that there can be many very different reasons why somebody can develop heart failure, and the ICD-10-CM coding system, as complex as it is, allows for very fine granuation in this respect. Therefore, your first decision to make, when looking for a code to use, is to determine, from the note, what is the underlying cause for heart failure. To illustrate, I am listing a few of the more common ICD-10 codes for heart failure based on cause:

  • I11.0 - Hypertensive heart disease with heart failure
  • I09.81 - Rheumatic heart failure
  • T86.22 - Heart transplant failure
  • I97.131 - Postprocedural heart failure following other surgery
  • I97.130 - Postprocedural heart failure following cardiac surgery
  • I13.0 - Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
  • P29.0 - Neonatal cardiac failure

Note that none of the above conditions where heart failure is present use the root "I50" for buidling the ICD-10 code.

How To Code If No Cause For Heart Failure Is Documented?

If no cause for heart failure is spcified in the note, it is better to code just the heart failure diagnosis alone (i.e. Systolic heart failure, for example), even if a secondary diagnosis is present in the note, such as hypertension. In other words, the medical coder does not have the liberty to makes the connection between another condition and heart failure, unless it is already present in the chart. In such a case, the coder should assign separate codes for the two conditions.