Partnership Guide 2023Congestive Heart Failure (CHF)

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Documentation of CHF should include:¹

Document all applicable symptoms and risk factors

Hypertension, Coronary Artery Disease, Ethnicity, Cardiomyopathy, Chest pain, Diabetes, Obesity, NSAID use, syncope, Fatigue

Document all applicable exam, laboratory, and imaging findings - Pulmonary edema, Edema, Echocardiogram, electrocardiogram, arrhythmmias,Chest X-ray, stress test, other imaging

Document full treatment plan including medication and devices

Medications - diuretics, Ace inhibitors, angiotensin II receptor blockers, digoxin, supplemental oxygen,

Surgical option - Bypass, valve repair, cardioverter defibrillator, ventricular assist, transplant, etc.

Dietary and exercise plans

Referral to cardiology or palliative care

Documentation for code selection

Describe the type of CHF as systolic, diastolic, or combined systolic and diastolic

Anatomoically relate the CHF as left or right side

Other types

Right heart failure due to left heart failure
Biventricular failure
High output failure
End stage failure (Stage D)

Note CHF as being acute, chronic, or acute on chronic

Provide treatment plan for the diagnosis

If known, link CHF to other associate conditions

Hypertension
CKD
Myocarditis
Takotsubo Syndrome - stress induced cardiomyopathy

img2Documentation and Coding

Code first for all heart failures in category I50: Heart failure due to hypertension, due to hypertensive CKD, following surgery, or rheumatic heart failure

img3img4Example*Patient is a 76 y/o WM with PMH of HTN, CHF and obesity. Presents for follow up of chronic conditions. Reports SOB on exertion.Social Hx-widowed, smokes 1PPD, moderate alcohol useBP 142/96 Pulse 88 Resp. 21 Ht. 5’11” Wt. 245 BMI: 34.2Med List -Lisinopril 20 mg 1 po qd; Furosemide 20mg, 1 po qd; ASA 81 mg 1 po qdLabs – Pt missed lab apptEcho report/Cardiology - diastolic left ventricular failureAssessment/PlanCHF- chronic, worsening, continue meds, followed by Dr. Smith, Cardiology. Follow/up Echo scheduled in 6 monthsHTN – continue medsObesity – continue prescribed LF dietCoded as:I11.0 Hypertensive heart disease with heart failureI50.32 Chronic diastolic (congestive) heart failureE66.0 ObesityZ68.34 BMI 34.0-34.9img5*The sole purpose of the examples is to demonstrate the application of coding guidelines discussed in the materials. Examples do not represent complete documentation of a condition, nor provide any clinical advice. Each patient and medical record is unique, and assignment of codes depends solely on the distinct documentation within an individual record.Providers must confirm the accuracy of their diagnoses to ensure that diagnosis and coding practices comply with ICD-10-CM Official Guidelines for Coding and Reporting and all applicable legal requirements. Failure to address diagnosis inaccuracies can result in administrative sanctions and potential financial penalties. Accurate coding and submission activities allow us to provide the best benefits and resources possible to our customers.This guide is informational and not meant to replace the clinician’s judgment when caring for the patient. Content updated April 20232023 Medicare Advantage Partnership GuideWelcomeContentsDocumentation Best Practices2023 Medicare Advantage ICD-10-CM Quick Reference Code GuideDisease-Specific Webinar LinksConditioning Reporting GuideReporting Common ConditionsAtrial FibrillationCancerChronic Kidney Disease (CKD)Chronic Obstructive Pulmonary Disease (COPD)Congestive Heart Failure (CHF)DVT and PEDementiaDiabetes Mellitus (DM)Major DepressionObesityPeripheral Artery Disease (PAD)Substance Use/Abuse/DependenceTobacco and E-Cigarette Use/AbuseSocial Determinants of Health