CHF readmits

A provider turned to us with concerns about CHF readmits. I found a major problem.  I13.0 and I13.2 codes. Pt was DC'd with a dx of "volume overload due to CKD" Pt also has htn and chronic CHF which will pull the above codes. Although the pt isn't in acute exacerbation of CHF it still gets put in the combination code. Pt returns within 30 days with the above dx but now in acute exacerbation of CHF. By using the I13.0 and I13.2 codes, the hospital is found to have a readmit of CHF within a 30 day period. Hospitals are held responsible for admits like this, but, the pt wasn't admitted due to heart failure. Are we coding the above situations wrong? Does it matter whether of not the pt has acute or chronic heart failure when using the I13 codes? Thank you



  • encourage your providers to clearly indicate the etiology of the fluid overload. If it is not related to the heart failure- state non cardiogenic fluid overload.
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