Narcolepsy is a long-term neurological disorder that affects the brain’s ability to control sleep-wake cycles. This chronic sleep disorder causes a person to suddenly fall asleep at inappropriate times. It is characterized by excessive sleepiness, sleep paralysis, overwhelming daytime drowsiness, hallucinations, and in some cases episodes of cataplexy (partial or total loss of muscle control, often triggered by a strong emotion such as laughter). Narcolepsy that occurs with cataplexy is called Type 1 narcolepsy. Narcolepsy that occurs without cataplexy is known as Type 2 narcolepsy. In most cases, people suffering from narcolepsy find it difficult to stay awake for long periods of time, regardless of the circumstances, which can in turn cause serious disruptions in their daily routine. There is no specific cure for narcolepsy; however, medications and behavioral lifestyle treatments or changes can help manage symptoms effectively. Medical coding for narcolepsy sleep disorder is quite challenging, as there are several rules related to reporting the procedure accurately. Reliable medical billing and coding companies can help physicians report this chronic sleep disorder correctly on their medical claims and obtain optimal reimbursement.
Narcolepsy affects both males and females equally. Reports from WUN (Wake up Narcolepsy – a non-profit organization that seeks to raise awareness about narcolepsy) suggest that narcolepsy affects about 1 in every 2,000 Americans and 3 million people worldwide. The typical onset of this condition is between the ages of 15 and 25, but can also become apparent at early childhood. In many cases, narcolepsy remains undiagnosed and, therefore, untreated. It is estimated that up to 50% of patients with Narcolepsy may be undiagnosed.
Typical Causes and Symptoms of Narcolepsy
The exact cause of narcolepsy is unknown. Researchers suggest that the condition may occur due to a combination of multiple factors that lead to neurological dysfunction and REM sleep disturbances. Nearly all people with narcolepsy who have cataplexy have extremely low levels of the naturally occurring chemical hypocretin, which promotes wakefulness and regulates REM sleep by the brain. Several other factors that cause this chronic sleep condition include – inherited genetic fault, autoimmune disorders, brain injuries and age and family history of the patient.
Even though narcolepsy is a lifelong problem, it does not worsen as the person ages. The symptoms may partially improve over time, but they will never disappear completely. The signs and symptoms may worsen for the first few years and then continue for life. The most typical symptoms are – excessive daytime sleepiness, sudden loss of muscle tone (cataplexy), sleep paralysis, changes in rapid eye movement (REM) sleep, hallucinations, fragmented sleep and insomnia, automatic behaviors, memory problems, headache and depression.
Diagnosing and Treating Chronic Sleep Disorder
Diagnosis of narcolepsy begins with a detailed clinical examination and review of the medical history of patients. Physicians may make a preliminary diagnosis of this condition by recording patient’s level of excessive daytime sleepiness and sudden loss of muscle tone (cataplexy). Patients may be asked to maintain a sleep journal noting the times of sleep and symptoms over a one- to two-week period. Several diagnostics tests like – Polysomnography (PSG) and multiple sleep latency test (MSLT) may be conducted to diagnose narcolepsy and determine its level of severity.
Although there is no cure for this sleep condition, the symptoms (EDS and symptoms of abnormal REM sleep, such as cataplexy) can be controlled in most people with drug treatment. Medications include – Stimulants (like Modafinil (Provigil) or Armodafinil (Nuvigil), Amphetamine-like stimulants, Methylphenidate (Aptensio XR, Concerta, and Ritalin), Sodium oxybate and other antidepressant drugs. Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run.
Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement.
ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. People with untreated symptoms are more likely to be involved in severe automobile accidents. However, these risks may be comparatively lower among individuals who regularly consume medications. Falling asleep suddenly or losing muscle control during normal activities can transform even safe actions into hazards. For workers, it is important to communicate with employers about their sleep disorder and work with them to find ways to accommodate their needs. The Americans with Disabilities Act (ADA) requires employers to provide reasonable accommodations for all employees with disabilities. Adults with narcolepsy can negotiate with employers to modify their work schedules in such a way that they can take naps in between (when essential) and perform the most demanding tasks when they are most alert.
Medical coding for narcolepsy sleep disorder can be complex. With all the challenges involved, the best option for sleep medicine physicians is to rely on specialized medical billing and coding services for timely and accurate claim submission. Expert teams in an established outsourcing company can handle all the billing and coding challenges competently and help healthcare providers maximize revenue cycle and improve patient care.
Periodontitis is a serious gum infection that damages the soft tissue and destroys the bone that supports your teeth. Also called gum disease or periodontal disease, this condition occurs due to poor brushing and flossing habits that allow plaque (a sticky film of bacteria) to build up around the tooth causing inflammation of the gums. This inflammation of the gums can result in redness, swelling and a tendency to bleed during tooth brushing. If left unchecked, the inflammation can spread down below the gums and along the roots of the teeth, causing possible destruction of the periodontal ligament and the supporting alveolar bones. Untreated periodontitis will eventually result in loosening and potential loss of the teeth. In addition, it may also increase the risk of stroke, heart attack and other health problems. Early identification of symptoms and related risk factors that could be directly contributing to this gum disease can help prevent the condition in the long run. As dental medical billing and coding is complex, physicians should correctly document the procedures performed in the medical records. Medical coding outsourcing is a feasible option for physicians to simplify their documentation process.
Reports from the Centers for Disease Control and Prevention (CDC), suggest that about half of Americans aged 30 years or older have periodontitis, the more advanced form of periodontal disease. The potential factors that can increase the risk of gum disease include – gingivitis, poor oral habits, smoking or chewing tobacco, hormonal changes, vitamin deficiencies and use of medications. Maintaining good oral hygiene is part of both treatment and prevention. However, surgical intervention may be suggested in some severe cases when these non-surgical measures are not effective.
Periodontitis versus Gingivitis
Gingivitis occurs before periodontitis. While, gingivitis occurs due to gum inflammation, periodontitis refers to gum disease and the destruction of tissue, bone, or both. In the early stages of gingivitis, the bacteria in plaque buildup, causing the gums to become inflamed and easily bleed during tooth brushing. However, no irreversible bone or other tissue damage may occur at this stage. Untreated gingivitis can progress to periodontitis, often without any obvious signs.
Identifying the Signs and Symptoms
Generally, gum disease may progress slowly without producing any specific symptoms, even in the late stages of the disease. The common signs and symptoms include –
- Inflamed or swollen gums and recurrent swelling in the gums
- Receding gums, which make the teeth, look longer
- Pus between the teeth and gums
- New spaces developing between your teeth
- Halitosis, or bad breath
- Gums that feel tender when touched
- Bright red, dusky red or purplish gums
- Bleeding gums
- A metallic taste in the mouth
- Loose teeth
- Painful chewing
- A change in the way your teeth fit together when you bite
Diagnosis and Treatment of Periodontitis
In most cases, a dentist/periodontist can normally diagnose periodontitis by analyzing the primary signs and symptoms and carrying out a mouth examination. The dentist will examine your mouth to look for plaque and tartar buildup and check for easy bleeding. They will measure the pocket depth of the groove between the gums and teeth by simply inserting a periodontal probe next to the tooth, under the gum line, usually at several sites throughout the mouth. If the tooth is healthy, the probe will not slide far below the gum line. On the other hand, if it is a case of periodontitis, the probe will reach deeper under the gum line. The dentist will measure how far the probe reaches. In addition, dental X-rays are taken to check for bone loss in areas where your dentist observes deeper pocket depths.
Treatment for this gum disease aims to clean the pockets around teeth and prevent damage to surrounding bones. Maintaining good oral hygiene is one of the primary methods to keep the teeth and gums healthy and prevent infection. Non-surgical treatment methods for this condition include – Scaling and cleaning (remove plaque and calculus to restore periodontal health), root planning and prescription medications like antimicrobial mouth rinse (such as chlorhexidine), antibiotic gels and microspheres, enzyme suppressants and other oral antibiotics. If good oral hygiene and non-surgical treatments are not effective, dental surgery may be necessary which include – Flap surgery (pocket reduction surgery), Soft tissue grafts, Guided tissue regeneration and bone grafting.
Dental billing and coding involves using the specific ICD-10 diagnosis codes for reporting various dental conditions such as – periodontitis on the medical claims they submit to health insurers for reimbursement.
ICD-10 Codes to Use
K05 – Gingivitis and periodontal diseases
K05.0 – Acute gingivitis
- K05.00 – Acute gingivitis, plaque induced
- K05.01 – Acute gingivitis, non-plaque induced
K05.1 – Chronic gingivitis
- K05.10 – Chronic gingivitis, plaque induced
- K05.11 – Chronic gingivitis, non-plaque induced
K05.2 – Aggressive periodontitis
- K05.20 – Aggressive periodontitis, unspecified
K05.21 – Aggressive periodontitis, localized
- K05.211 – Aggressive periodontitis, localized slight
- K05.212 – Aggressive periodontitis, localized moderate
- K05.213 – Aggressive periodontitis, localized severe
- K05.219 – Aggressive periodontitis, localized unspecified severity
K05.22 – Aggressive periodontitis, generalized
- K05.221 – Aggressive periodontitis, generalized, slight
- K05.222 – Aggressive periodontitis, generalized, moderate
- K05.223 – Aggressive periodontitis, generalized, severe
- K05.229 – Aggressive periodontitis, generalized, unspecified severity
K05.3 – Chronic periodontitis
- K05.30 – Chronic periodontitis, unspecified
K05.31 – Chronic periodontitis, localized
- K05.311 – Chronic periodontitis, localized, slight
- K05.312 – Chronic periodontitis, localized, moderate
- K05.313 – Chronic periodontitis, localized, severe
- K05.319 – Chronic periodontitis, localized, unspecified severity
K05.32 – Chronic periodontitis, generalized
- K05.321 – Chronic periodontitis, generalized, slight
- K05.322 – Chronic periodontitis, generalized, moderate
- K05.323 – Chronic periodontitis, generalized, severe
- K05.329 – Chronic periodontitis, generalized, unspecified severity
K05.4 – Periodontosis
K05.5 – Other periodontal diseases
K05.6 – Periodontal disease, unspecified
How to Prevent Periodontitis
The American Academy of Periodontology reports that about 30% of Americans may be genetically susceptible to gum disease. Periodontitis is a chronic, or long-term, inflammatory disease, which will recur if good oral hygiene is not maintained properly. Incorporating good oral hygiene and dental care practices can help to prevent the occurrence of periodontitis. Proper dental care involves brushing your teeth at least twice a day and flossing once a day. Brushing removes plaque from the surfaces of the teeth and flossing removes food particles and plaque from in between the teeth and under the gum line. Antibacterial rinses can reduce bacteria that cause plaque and gum disease. Apart from these oral hygiene practices, various other health and lifestyle changes like – quitting the habit of smoking, consuming a well-balanced diet and avoiding clenching and grinding your teeth can help reduce the severity and pace of gum disease development in the long run.
Medical coding for periodontitis/gum disease can be a challenging process. For correct and timely medical billing and claims submission, healthcare practices can outsource their medical coding tasks to a reliable and reputable medical billing and coding outsourcing company that provides the services of AAPC-certified coding specialists.
Crohn’s disease and ulcerative colitis are chronic inflammatory diseases of the gastrointestinal tract. Crohn’s involves inflammation in lining of digestive tract. From a medical coding service provider’s standpoint, proper documentation by the physician specifying the location of the Crohn’s disease, as well as any complications or manifestations is necessary for proper code selection.
The symptoms of Crohn’s disease depend on the location, the extent, and the severity of the inflammation. The common signs and symptoms of Crohn’s include bloody diarrhea, abdominal pain, fatigue, weight loss, and skin lesions. Crohn’s can present at any age but will more often develop at a younger age. It can also affect people in the 50s and 60s. Other risk factors include genetics, smoking medications, diet, certain bacterial infections, and environmental aspects.
Symptoms can be subtle and mild or severe and obvious. If the inflammation spreads deep into the tissues, it can even result in perforation of the intestine. Though it is a chronic disease, controlling Crohn’s can help people lead a normal life. Early diagnosis and treatment can help prevent serious complications.
Clear and Precise Documentation for Diagnosis Coding
Crohn’s disease is diagnosed using colonoscopy and radiological studies such as barium enema, upper GI series with small bowel follow-through, and CT scans of the abdomen and pelvis. The documentation should clearly indicate the location of the Crohn’s disease, extent of the affected area, severity, and complications.
- Location and extent of affected area
Crohn’s includes the small intestine, large intestine, both small and large intestine, and unspecified. Crohn’s and ulcerative colitis have similar symptoms but there are differences:
- While ulcerative colitis is limited to the colon, Crohn’s typically affects the end of the small bowel and the beginning of the colon, but can affect any part of the gastrointestinal (GI) tract.
- In Crohn’s disease, the intestine is a mix of healthy parts and inflamed areas. Ulcerative colitis involves continuous inflammation of the colon.
- Crohn’s disease can occur in all the layers of the bowel wall, while ulcerative colitis affects only the inner most lining of the colon.
To ensure accurate ICD-10 code selection for Crohn’s disease, the documentation should clearly specify the location and extent of the affected area
- Small intestine (duodenum, ileum, jejunum) (regional or terminal)
- Large intestine (colon, large bowel, rectum) (granulomatous colitis or regional colitis), or
- Small and large intestine
The various subtypes of Crohn’s disease and their symptoms are:
Crohn’s enteritis – inflammation confined to the small intestine
Crohn’s colitis – inflammation confined to the colon
Crohn’s entero-colitis and ileo-colitis – inflammation that involves both the small intestine and the colon
Crohn’s terminal ileitis – inflammation that affects only the very end of the small intestine
In addition to the location of the Crohn’s disease, any complication or manifestation must be clearly documented. Complications of Crohn’s disease may or may not be related to the intestinal inflammation. Intestinal complications of Crohn’s disease include
- Rectal bleeding
- Obstruction and perforation of the small intestine or colon
- Unspecified complications
Rare but potentially life-threatening complications such as extensive distention of the colon and perforation of the intestine may require surgery.
Other complications not related to inflammation of the intestine include:
- Skin lesions on the legs and ankles
- Painful eye conditions
- Arthritis-related joint pain and swelling
- Hepatitis or bile ducts (primary sclerosing cholangitis)
- Nutritional deficiencies
ICD-10 Codes for Crohn’s Disease
Including all these necessary details in the medical record will allow the medical coder to assign the appropriate ICD-10 code (“with complications” or “without complications”).
- K50.00, Crohn’s disease of small intestine without complications
- K50.10, Crohn’s disease of large intestine without complications
- K50.80, Crohn’s disease of both small and large intestine without complications
- K51.00, Ulcerative pancolitis without complications
- K51.30, Ulcerative rectosig moiditis without complications
- K50.011 Crohn’s disease of small intestine with rectal bleeding
- K50.012 Crohn’s disease of small intestine with intestinal obstruction
- K50.013 Crohn’s disease of small intestine with fistula
- K50.014 Crohn’s disease of small intestine with abscess
- K50.018 Crohn’s disease of small intestine with other complication
- K50.019 Crohn’s disease of small intestine unspecified complications
- K50.10 Crohn’s disease of large intestine without complications
- K50.111 Crohn’s disease of large intestine with rectal bleeding
- K50.112 Crohn’s disease of large intestine with intestinal obstruction
- K50.113 Crohn’s disease of large intestine with fistula
- K50.114 Crohn’s disease of large intestine with abscess
- K50.118 Crohn’s disease of large intestine with other complication
- K50.119 Crohn’s disease of large intestine unspecified complications
- K50.80 Crohn’s disease of both small and large intestine without complications
- K50.811 Crohn’s disease of both small and large intestine with rectal bleeding
- K50.812 Crohn’s disease of both small and large intestine with intestinal obstruction
- K50.813 Crohn’s disease of both small and large intestine with fistula
- K50.814 Crohn’s disease of both small and large intestine with abscess
- K50.818 Crohn’s disease of both small and large intestine with other complication
- K50.819 Crohn’s disease of both small and large intestine unspecified complications
- K50.90 Crohn’s disease, unspecified without complication
- K50.911 Crohn’s disease, unspecified with rectal bleeding
- K50.912 Crohn’s disease, unspecified with intestinal obstruction
- K50.913 Crohn’s disease, unspecified with fistula
- K50.914 Crohn’s disease, unspecified with abscess
- K50.918 Crohn’s disease, unspecified with other complication
- K50.919 Crohn’s disease, unspecified with unspecified complications
Coding inflammatory diseases of the gastrointestinal tract are clearly dependent on the physician documentation in the medical record. With diagnosis, management, and treatment clearly documented in the physician’s report, medical coding companies can help gastroenterologists submit error-free claims for optimal reimbursement.
Respiratory failure refers to a syndrome which occurs when the respiratory system fails in one or both of its gas exchange functions – oxygenation and carbon dioxide elimination. The condition happens when the capillaries or tiny blood vessels (surrounding your air sacs) can’t properly exchange carbon dioxide for oxygen. Respiratory failure may be acute or chronic. Typically treated as a medical emergency, acute respiratory failure (ARF) occurs when fluid builds up in the air sacs in your lungs, which stops lungs from releasing oxygen into your blood. If not treated quickly, this condition in most cases may lead to death. With appropriate and timely treatment, the serious complications caused by acute respiratory failure can be reversed. Documentation is important to ensure appropriate care and accurate reimbursement, and medical coding outsourcing is an ideal option for physicians to simplify their documentation process.
Acute respiratory failure (ARF) is classified as hypoxemic (low arterial oxygen levels), hypercapnic (elevated levels of carbon dioxide gas), or a combination of the two. In most cases one or the other predominates. There are various causes associated with this respiratory condition which include – obstruction (like chronic obstructive pulmonary disease (COPD) or asthma), injury to the spinal cord, brain, ribs or chest (that affect breathing process), acute respiratory distress syndrome (ARDS), drug or alcohol abuse, toxic chemical inhalation, stroke and other infections of the lungs. When compared to chronic respiratory failure (which is an ongoing condition) the acute respiratory failure occurs suddenly and lasts for a short time.
Signs and Symptoms
In most cases, patients with ARF will experience some degree of respiratory difficulty. The common signs and symptoms of this condition will generally depend on its underlying causes and the levels of oxygen and carbon dioxide in your blood. Some of the most common signs and symptoms include –
- Rapid breathing
- Air hunger (feeling like you can’t get as much air as you need)
- Restlessness, confusion and anxiety
- Rapid and shallow breathing
- Racing heart
- Profuse sweating
- Loss of consciousness
- Irregular heartbeats (arrhythmias)
- Bluish coloration in the skin, fingertips, or lips
- Inability to breathe
Persons with a family history of chronic (long-term) respiratory problems, who smoke tobacco products, drink alcohol excessively and who sustain an injury to the spine, brain, or chest may be at high risk of suffering this acute respiratory condition.
How to Diagnose and Document ARF
Acute respiratory failure is a condition that requires immediate medical condition. Therefore, patients must be supplied with oxygen that helps them to breathe normally, and prevents tissue death in the brain and other organs. Once the patient’s condition is stabilized, physicians may begin steps to fully diagnose the condition.
As part of initial diagnosis, physicians may conduct a detailed physical examination and evaluate your previous health history. They may also check your body’s oxygen and carbon dioxide levels with a pulse oximetry device and an arterial blood gas test. In addition, a chest X-ray will also be conducted to search for abnormalities in the lungs.
Treatment for this condition typically depends on the underlying conditions a person suffers from and may include pain medications or other medicines that help patients breathe better. In some cases, oxygen may be supplied from an oxygen tank if a patient can’t breathe adequately on their own. For patients who require prolonged ventilator support, an operation called tracheostomy (that creates an artificial airway in the windpipe) may be performed.
Pulmonary medical coding involves using the specific ICD-10 diagnosis codes for reporting acute respiratory failure (ARF) on the medical claims they submit to health insurers for reimbursement.
ICD-10 Codes to Use
J96 – Respiratory failure, not elsewhere classified
J96.0 – Acute respiratory failure
- J96.00 – Acute respiratory failure, unspecified whether with hypoxia or hypercapnia
- J96.01 – Acute respiratory failure, with hypoxia
- J96.02 – Acute respiratory failure, with hypercapnia
J96.2 – Acute and chronic respiratory failure
- J96.20 – Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia
- J96.21 – Acute and chronic respiratory failure, with hypoxia
- J96.22 – Acute and chronic respiratory failure, with hypercapnia
J96.9 – Respiratory failure, unspecified
- J96.90 – Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia
- J96.91 – Respiratory failure, unspecified, with hypoxia
- J96.92 – Respiratory failure, unspecified, with hypercapnia
Acute respiratory failure (ARF) is a condition that can cause long-term damage to the lungs and therefore it is important to seek medical care if you are experiencing any specific symptoms of this condition. Appropriate treatment helps in better lung function. People suffering from respiratory failure can also benefit from pulmonary rehabilitation, which includes exercise therapy, education, and counseling.
Medical coding for respiratory failure can be a challenging process. For correct and timely medical billing and claims submission, healthcare practices can outsource their medical coding tasks to a reliable and established medical billing and coding outsourcing company that provides the services of AAPC-certified coding specialists.
Heart disease is the most common cause of death and disability in men in the U.S. According to the American Heart Association, 1 in 3 American men suffer from one or more cardiovascular conditions, and every year 1 in 4 of them dies. The nuances of diagnosing, documenting, and coding heart failure and related conditions are numerous. There are major ICD-10 updates to report heart failure in fiscal year (FY) 2018. Medical coding outsourcing is a feasible option to handle coding challenges and submit claims to accurately reflect the severity of illness, which impacts quality and reimbursement.
The heart’s pumping action delivers oxygen- and nutrient-rich blood to the body’s cells, allowing the body to function normally. Heart failure is a chronic, progressive condition in which the heart muscle is not able to pump enough blood through to meet the body’s requirements. FY 2018 ICD-10 updates include a new subcategory I50.8- to identify and report the several different and specific types of heart failure such as left-sided heart failure and right-sided heart failure.
Left-sided heart failure
The left ventricle provides the main pumping power of the heart and left-sided heart failure occurs when the left side of the heart must work harder to pump the same amount of blood. There are two types of left-sided heart failure:
- Heart failure with reduced ejection fraction (HFrEF) or systolic failure: The left ventricle loses its ability to contract normally, with the result that the heart is unable to pump with enough force to push enough blood into circulation.
- Heart failure with preserved ejection fraction (HFpEF) or diastolic failure/dysfunction: This type of heart failure occurs when the left ventricle becomes stiffer than normal and does not relax the way it should. The heart cannot properly fill with blood during the resting period.
Right-sided heart failure
The right heart ventricle pumps blood to the lungs to collect oxygen. Right-sided heart failure occurs as a result of left-sided heart failure. When the left ventricle is unable to pump blood efficiently, the blood backs up in the veins. This typically causes swelling in the legs and ankles, and swelling within the abdomen such as the GI tract and liver.
Congestive heart failure
Congestive heart failure (CHF) is the stage in which fluid builds up around the heart and affects its normal pumping action. If fluid collects in the lungs, it interferes with breathing and causes shortness of breath, a condition called pulmonary edema. Heart failure also affects the kidney function and causes edema or swelling in the body’s tissues.
Biventricular heart failure occurs when heart failure affects both sides of the heart. End-stage heart failure is the final stage of the disease (Stage D).
New ICD-10 Codes and Descriptions for Heart Failure in 2018
In 2018, heart failure coding includes the following changes:
- I50.810 Right heart failure, unspecified (right heart failure without mention of left heart failure or right ventricular failure)
- I50.811 Acute right heart failure (acute isolated right heart failure or acute (isolated) right ventricular failure)
- I50.812 Chronic right heart failure (chronic isolated right heart failure or chronic (isolated) right ventricular failure)
- I50.813 Acute on chronic right heart failure (acute on chronic isolated right heart failure, acute on chronic (isolated) right ventricular failure, acute decompensation of chronic (isolated) right ventricular failure or acute exacerbation of chronic (isolated) right ventricular failure
- I50.814 Right heart failure due to left heart failure (right ventricular failure secondary to left ventricular failure)
Code also the type of left ventricular failure, if known (I50.2-I50.43)
Excludes1: Right heart failure with but not due to left heart failure (I50.82)
- I50.82 Biventricular heart failure
Code also the type of left ventricular failure as systolic, diastolic, or combined, if known (I50.2-I50.43)
- I50.83 High output heart failure
- I50.84 End-stage heart failure (stage D heart failure)
- I50.89 Other heart failure
- New guidelines for subcategories I50.2-I50.4 instruct: “Code also end stage heart failure, if applicable (I50.84)”.
- 150.1 is revised, to “Left ventricular failure, unspecified.”
- I50.2 Systolic (congestive) heart failure adds two definitions:
- Heart failure with reduced ejection fraction [HFrEF]
- Systolic left ventricular heart failure
Code also end stage heart failure, if applicable (I50.84)
- I50.3 Diastolic (congestive) heart failure adds three definitions:
- Diastolic left ventricular heart failure
- Heart failure with normal ejection fraction
- Heart failure with preserved ejection fraction [HFpEF]
Code also end stage heart failure, if applicable (I50.84)
- Category I50.4 Combined systolic (congestive) and diastolic (congestive) heart failure adds two definitions:
- Combined systolic and diastolic left ventricular heart failure
- Heart failure with reduced ejection fraction and diastolic dysfunction
Code also end stage heart failure, if applicable (I50.84)
- I50.82 and I50.84 note to “Code also the type of left ventricular failure, such as systolic, diastolic, or combined, if known (I50.2-I50.4)
Deleted inclusion terms: The notes with existing code I50.9 (Heart failure, unspecified) have certain deletions in ICD-10 2018.
- Biventricular (heart) failure NOS
The ICD-10 code for biventricular heart failure in 2018 is I50.82
- Right ventricular failure (secondary to left heart failure)
The ICD-10 code for right heart failure due to left heart failure in 2018 is I50.814
Fiscal year (FY) 2018 ICD-10 updates include about 360 new codes, 142 deletions, and 226 code revisions. Experienced coders in medical coding companies are knowledgeable about these code updates including inclusion terms and exclusion notes, and can ensure proper code assignment based on physician documentation of the type and acuity of the heart failure. They also have a thorough knowledge of payer rules and guidelines which is critical to ensure proper accurate claim submission and reimbursement.