Sequencing 428.23 vs. 404.91 (Hyerptensive Heart Failure)
Hypertensive Heart Failure and CKD with Acute CHF
Several have either called or e-mailed me asking my opinion regarding the sequencing of 'Acute forms of CHF with the Heart Disease Documented as Hypertensive'. This was the topic of a recent ACDIS Conference Call.
The Current Coding Guidelines state one must use the 404.XX series as the PDX and 'code also' the specific form of CHF.
(This is a very involved section of coding and this message does not attempt to address all of the issues regarding hypertensin, CKD and CHF.)
Citation: ICD-9-CM Official Guidelines for Coding and Reporting Effective October 1, 2009 Page 8 of 112
"Etiology/manifestation convention (“code firstâ€, “use additional code†and “in diseases classified elsewhere†notes)
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-9-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a “use additional code†note at the etiology code, and a “code first†note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. "
The ICD Tabular and Coding Instructions state to use 'an additional code' to report the specific type of CHF and the codes following are for forms of Acute Diastolic/Systolic and Combined Systolic/Diastolic CHF.
Reference: Coding Clinic
AHA Coding Clinicâ for ICD-9-CM, 1Q 1993, Volume 10, Number 1, Pages 19-20
Question:
How should a diagnosis of congestive heart failure due to diastolic dysfunction due to hypertension be coded?
Answer:
You will now need three codes to completely describe this diagnosis. Assign codes 402.91,
Hypertensive heart disease, unspecified with heart failure; 428.30, Diastolic heart failure, unspecified; and 428.0, Congestive heart failure, unspecified.
The two additional codes provide the specificity required to report that the heart failure was diastolic type and congestive.
Thanks,
Paul Evans, RHIA, CCS, CCS-P
Several have either called or e-mailed me asking my opinion regarding the sequencing of 'Acute forms of CHF with the Heart Disease Documented as Hypertensive'. This was the topic of a recent ACDIS Conference Call.
The Current Coding Guidelines state one must use the 404.XX series as the PDX and 'code also' the specific form of CHF.
(This is a very involved section of coding and this message does not attempt to address all of the issues regarding hypertensin, CKD and CHF.)
Citation: ICD-9-CM Official Guidelines for Coding and Reporting Effective October 1, 2009 Page 8 of 112
"Etiology/manifestation convention (“code firstâ€, “use additional code†and “in diseases classified elsewhere†notes)
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-9-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a “use additional code†note at the etiology code, and a “code first†note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. "
The ICD Tabular and Coding Instructions state to use 'an additional code' to report the specific type of CHF and the codes following are for forms of Acute Diastolic/Systolic and Combined Systolic/Diastolic CHF.
Reference: Coding Clinic
AHA Coding Clinicâ for ICD-9-CM, 1Q 1993, Volume 10, Number 1, Pages 19-20
Question:
How should a diagnosis of congestive heart failure due to diastolic dysfunction due to hypertension be coded?
Answer:
You will now need three codes to completely describe this diagnosis. Assign codes 402.91,
Hypertensive heart disease, unspecified with heart failure; 428.30, Diastolic heart failure, unspecified; and 428.0, Congestive heart failure, unspecified.
The two additional codes provide the specificity required to report that the heart failure was diastolic type and congestive.
Thanks,
Paul Evans, RHIA, CCS, CCS-P