When ACUTE (only) SYSTOLIC / DIASTOLIC CHF is assigned with PDX HTN heart disease, (I110) it is an MCC (since Oct 2018). (Acute on chronic CHF remains an MCC when PDX is HTN Heart and CKD dis)

But when you assign ACUTE (only) COMBINED SYST / DIAST CHF it is not considered an MCC..

Our coding QA explained it is on the excludes list but had no further information on why combined CHF would be excluded as an MCC when systolic/diastolic only CHF are not.

Anyone have information on why this would be?

Thank you!


  • Our regulatory committee has a member who is going to be attending the coordination and maintenance committee and this is one of the issues which has been put forth as needing clarification from CMS on.

    Frankly it seems like an error or an oversight but it COULD have just resulted from an anomaly based on a statistical analysis of the average charges submitted for these conditions and CMS could have just been applying a math formula for it to come out this way.

    At this one really knows. 
Sign In or Register to comment.