ICD-10 Coding for Congestive Heart Failure with Reduced Ejection Fraction(I50.21, I50.22, I50.23)
Complete ICD-10-CM coding and documentation guide for Congestive Heart Failure with Reduced Ejection Fraction. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Congestive Heart Failure with Reduced Ejection Fraction
I50.2-I50.23Primary Range
Systolic (congestive) heart failure
This range includes codes for acute, chronic, and acute on chronic systolic heart failure, which are directly related to HFrEF.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I50.21 | Acute systolic (congestive) heart failure | Use for new-onset acute heart failure with reduced ejection fraction. |
|
| I50.22 | Chronic systolic heart failure | Use for stable chronic heart failure with reduced ejection fraction. |
|
| I50.23 | Acute on chronic systolic heart failure | Use for acute exacerbation of chronic heart failure with reduced ejection fraction. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for congestive heart failure with reduced ejection fraction
Essential facts and insights about Congestive Heart Failure with Reduced Ejection Fraction
Primary ICD-10-CM Codes for congestive heart failure with reduced ejection fraction
Decision Criteria
clinical Criteria
- EF ≤40% with acute heart failure symptoms
documentation Criteria
- Explicit mention of 'acute systolic heart failure'
Applicable To
- Acute heart failure with reduced ejection fraction
Clinical Validation Requirements
- EF ≤40%
- Acute symptoms such as orthopnea or paroxysmal nocturnal dyspnea
- BNP >500 pg/mL
Code-Specific Risks
- Misclassification if EF is not documented
- Incorrect use if chronic symptoms are present
Coding Notes
- Ensure EF is documented as ≤40% to support this code.
I50.22 - Chronic systolic heart failure
Use for stable chronic heart failure with reduced ejection fraction.
Applicable To
- Chronic heart failure with reduced ejection fraction
Excludes
- Diastolic heart failure (I50.3-)
- Combined systolic and diastolic heart failure (I50.4-)
Clinical Validation Requirements
- EF ≤40%
- Stable symptoms such as fatigue or dyspnea on exertion
- Prior diagnosis of heart failure
Coding Notes
Document EF and chronicity clearly to support this code.
I50.23 - Acute on chronic systolic heart failure
Use for acute exacerbation of chronic heart failure with reduced ejection fraction.
Applicable To
- Acute exacerbation of chronic heart failure with reduced ejection fraction
Excludes
- Diastolic heart failure (I50.3-)
- Combined systolic and diastolic heart failure (I50.4-)
Clinical Validation Requirements
- EF ≤40%
- Acute decompensation on top of chronic symptoms
- New or worsening pulmonary edema
Coding Notes
Document both acute and chronic aspects to support this code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Acute diastolic (congestive) heart failure
I50.31Chronic diastolic (congestive) heart failure
I50.32Acute on chronic diastolic heart failure
I50.43Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Congestive Heart Failure with Reduced Ejection Fraction to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I50.21.
Impact
Clinical: Inaccurate treatment plans due to lack of specificity., Regulatory: Potential for audit due to non-specific coding., Financial: Reduced reimbursement from non-specific DRG assignment.
Mitigation Strategy
Always document whether heart failure is systolic or diastolic., Include EF values in documentation.
Impact
Reimbursement: Lower reimbursement due to non-specific DRG assignment., Compliance: Increased risk of audit due to lack of specificity., Data Quality: Poor data quality affecting clinical decision-making.
Mitigation Strategy
Specify systolic or diastolic and acuity to use specific codes like I50.21, I50.22, or I50.23.
Impact
Risk of audits due to non-specific heart failure coding.
Mitigation Strategy
Ensure documentation includes EF and specifies systolic or diastolic heart failure.
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 Congestive Heart Failure with Reduced Ejection Fraction, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Congestive Heart Failure with Reduced Ejection Fraction
Use these documentation templates to ensure complete and accurate documentation for Congestive Heart Failure with Reduced Ejection Fraction. These templates include all required elements for proper coding and billing.
Acute on chronic systolic heart failure management
Specialty: CardiologyRequired Elements
- EF percentage
- Acuity of heart failure
- Etiology of heart failure
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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