Cardiomyopathy and HTN heart linkage question
Query was sent with the following options-
Please provide etiology of CHF:
- CHF due to hypertension
- CHF due to valvular heart disease
- CHF due to NICM
Q response- The patient has CHF due to NICM
CDI note stated- no etiology of NICM given so presumed HTN
The guidelines say-
HYPERTENSIVE HEART DISEASE
ICD-10-CM presumes a causal relationship between hypertension and heart involvement and classifies hypertension and heart conditions to category I11, Hypertensive heart disease, as the two conditions are linked by the term "with" in the Alphabetic Index. These conditions should be coded as related even in the absence of provider documentation explicitly linking them. Code first I11.0, Hypertensive heart disease with heart failure, as instructed by the note at category I50, Heart failure. However, if the provider has specifically documented different causes for the hypertension and the heart condition, code the heart condition (I50.-, I51.4-I51.7, I51.89, I51.9) and hypertension separately. Sequencing of these conditions depends on the circumstances of the admission/encounter.
My question is- what constitutes "heart disease" for the purposes of this guideline.
Only CHF?
CHF and cardiomyopathy?
Since CM and CHF are not the same thing- how would you code the above scenario.
My HF review team considers CHF as the only heart disease this guideline represents. We would now require a query for etiology of NICM with Query options like this- ie- CHF d/t NICM d/t HTN- bc there is no auto linkage between NICM and HTN. But the more I read the guideline- I don't think we are correct.
Any thoughts or help would be greatly appreciated.
Comments
The 2023 ICD-10-CM Expert for Hospitals:
with
Heart failure (congestive) I11.0
heart involvement (I50.- or I51.4 - I51.7, I51.89, I51.9, due to hypertension - see
Hypertension, heart