ICD-10 Coding for End Stage Heart Failure(I50.84)
Complete ICD-10-CM coding and documentation guide for End Stage Heart Failure. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to End Stage Heart Failure
I50.84Primary Range
End stage heart failure
Primary code for documenting end stage heart failure, indicating advanced disease stage.
Hypertensive heart disease
Used when hypertensive heart disease is present with heart failure.
Ischemic cardiomyopathy
Used when ischemic heart disease is the underlying cause of heart failure.
Key Information: ICD-10 code for end stage heart failure
Essential facts and insights about End Stage Heart Failure
Primary ICD-10-CM Code for end stage heart failure
Decision Criteria
clinical Criteria
- Presence of NYHA Class IV symptoms
documentation Criteria
- Documented ejection fraction and heart failure type
Applicable To
- Stage D heart failure
Excludes
- Heart failure with preserved ejection fraction (HFpEF)
- Heart failure with reduced ejection fraction (HFrEF)
Clinical Validation Requirements
- NYHA Class IV symptoms at rest
- ≥3 hospitalizations in 6 months despite GDMT
- BNP > 400 pg/mL
Code-Specific Risks
- Misuse without specifying heart failure type
- Incorrect sequencing with hypertensive heart disease
Coding Notes
- Ensure documentation includes heart failure type and etiology.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Hypertensive heart disease with heart failure
I11.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting End Stage Heart Failure to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I50.84.
Impact
Clinical: Leads to inadequate treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Use specific clinical terms., Include all relevant clinical data.
Impact
Reimbursement: May result in denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Always pair with a secondary code indicating heart failure type.
Impact
Risk of audits due to missing heart failure type or etiology.
Mitigation Strategy
Implement thorough documentation practices.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for End Stage Heart Failure, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for End Stage Heart Failure
Use these documentation templates to ensure complete and accurate documentation for End Stage Heart Failure. These templates include all required elements for proper coding and billing.
End Stage Heart Failure with Hypertension
Specialty: CardiologyRequired Elements
- Heart failure type
- Ejection fraction
- NYHA class
- Therapeutic limitations
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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