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Proper coding of cerebrovascular accident (CVA) and congestive heart failure (CHF)


It’s important to follow the ICD-10 guidelines to ensure you’re coding conditions properly. Here are some important tips.
 

CVA

  • I60–I63 codes are rarely, if ever, coded in the office setting, since CVA is an emergent, acute event
    • For previous CVA with current, residual effects, code from I69.
    • For previous CVA without current, residual effects, code Z86.73.
    • Always document each CVA occurrence by date in prior medical history.
    • Initially write out, in full, “cerebrovascular accident” followed by “CVA” in parenthesis, and then use just “CVA” throughout the remainder of the note.

CHF

  • ICD-10-CM Category I50 “Heart failure” has “Code First” instructional notes that include:
    • Heart failure due to hypertension (I11.0)
    • Heart failure due to hypertension with chronic kidney disease (I13._)
    • Heart failure following surgery (I97.13_)
    • Rheumatic heart failure (I09.81)

ICD-10-CM description*:

  • I50.1_ Left ventricular failure, unspecified
  • I50.2_ Systolic (congestive) heart failure
  • I50.3_ Diastolic (congestive) heart failure
  • I50.4_ Combined systolic and diastolic (congestive) heart failure
  • I50.8_ Other heart failure
  • I50.9_ Heart failure, unspecified

*In these descriptions, the fourth character specifies the type of heart failure. The fifth character indicates acute, chronic, or acute on chronic.
 

Codes categorized to I50.2_ – I50.4_:

  • Include an instructional note to code also end stage heart failure (I50.84), if applicable.
  • Include the descriptor “congestive” as a nonessential modifier (an additional word that may be present or absent in the diagnostic statement without affecting the assigned code).
  • When documentation lists congestive heart failure along with either systolic or diastolic heart failure, only code for the type of heart failure noted.
  • In ICD-10-CM, “heart failure” and “congestive heart failure” both are coded I50.9_ Heart failure unspecified
     

Subcategory I50.8:

Other heart failure: further divided into right, biventricular, high output, end-stage, other and unspecified heart failure
 

ICD-10-CM description:

  • I50.810 Right heart failure, unspecified
  • I50.811 Acute right heart failure
  • I50.812 Chronic right heart failure
  • I50.813 Acute on chronic right heart failure
  • I50.814 Right heart failure due to left heart failure (excludes right heart failure with, but not due to, left heart failure (I50.82))
  • I50.82 Biventricular heart failure
  • I50.83 High-output heart failure
  • I50.84 End-stage heart failure
  • I50.89 Other heart failure


Codes I50.82 and I50.84:

Include an instructional note to code the type of heart failure as systolic, diastolic or combined (I50.2–I50.43), if known.


Diastolic or systolic dysfunction with acute or chronic heart failure:
There are 12 codes in the I50.1–I50.4 range that allow for specificity of systolic, diastolic or combined heart failure with further specificity for acute, chronic, acute on chronic or unspecified. Use the default code I50.9 when the documentation does not specify the type.


Our nurse educator plays an important role by working to ensure that providers accurately document conditions. For additional information about our AAPC CEU webinars or private, non-CEU education sessions, email us at RiskAdjustment@aetna.com.