CONGESTIVE HEART FAILURE

Terminology Differences & Increased Specificity 

The terminology used in ICD-10 exactly matches the types of CHF. If you document “decompensation” or “exacerbation,” the CHF type will be coded as “acute on chronic.” 

When documenting CHF, include the following: 

1. Cause e.g. Acute, chronic 

2. Severity e.g. Systolic, diastolic

ICD-10 Code Examples

I50.23 Acute on chronic systolic (congestive) heart failure 

I50.33 Acute on chronic diastolic (congestive) heart failure 

I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure

UNDERDOSING

Terminology Difference Underdosing is an important new concept and term in ICD-10. 

It allows you to identify when a patient is taking less of a medication than is prescribed. 

When documenting underdosing, include the following: 

1. Intentional, Unintentional, Non-compliance Is the underdosing deliberate? (e.g., patient refusal) 

2. Reason Why is the patient not taking the medication? (e.g.financial hardship, age-related debility) 

ICD-10 Code Examples

Z91.120 Patient’s intentional underdosing of medication regimen due to financial hardship 

T36.4x6A Underdosing of tetracyclines, initial encounter 

T45.526D Underdosing of antithrombotic drugs, subsequent encounter

ATHEROSCLEROTIC HEART DISEASE WITH ANGINA PECTORIS

Terminology Difference 

When documenting atherosclerotic heart disease with angina pectoris, include the following: 

1. Cause Assumed to be atherosclerosis; notate if there is another cause

2. Stability e.g. Stable angina pectoris, unstable angina pectoris 

3. Vessel Note which artery (if known) is involved and whether the artery is native or autologous

4. Graft involvement If appropriate, whether a bypass graft was involved in the angina pectoris diagnosis; also note the original location of the graft and whether it is autologous or biologic

ICD-10 Code Examples

I25.110 Atherosclerotic heart disease of a native coronary artery with unstable angina pectoris I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris