Guest post: 2018 ICD-10 codes—when the heart needs a helping hand

by Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS

Congestive heart failure (CHF) is a commonly diagnosed condition where the ventricles or the lower chambers of the heart do not work effectively. The heart serves as a pump to get blood in and then out of the heart to circulate to the rest of the body. When any type of pump doesn’t work efficiently backups can occur.

The most common form of CHF is left ventricular failure, however left-sided failure can also lead to right ventricular failure as a ripple effect. There are two common types of CHF, one whereby the ventricle cannot contract normally, known as systolic heart failure, and one where the ventricle cannot relax normally due to stiffness, known as diastolic failure. Some patients may have a combination of both systolic and diastolic failure.

The causes of heart failure include hypertension, coronary artery disease, and valvular diseases, as well as cardiomyopathies.

Coding for CHF

In ICD-10-CM, heart failure codes are included in category I50.-. For fiscal year (FY) 2018, right heart failure (I50.81-) as well as biventricular failure (I50.82) have been assigned specific codes instead of being included in the heart failure, unspecified code (I50.9). A new code is also being added to identify high output heart failure (I50.83).

Normally, a patient with heart failure has either normal or low cardiac output, but some patients can have a high output that is related to excessive vasodilation caused by underlying conditions such as obesity, arteriovenous shunts, and liver disease. The symptoms are the same as other types of heart failure such as dyspnea, congestion, and a normal ejection fraction. Another new addition is the identification of end-stage heart failure (I50.84).

Per the American Heart Association, end-stage heart failure affects about 10% of the heart failure population. Heart failure can be classified either by classes I-IV or by classes A-D. Patients with end-stage heart failure are considered Class IV or Class D, where conventional heart therapies and symptom management no longer work.

Treatment

Heart failure is most commonly treated with a healthy lifestyle and pharmaceutical management such as ACE inhibitors and beta blockers. However, in the more advanced stages, surgical intervention may be necessary.

Surgical treatment options can include inserting electronic or biological devices such as cardiac resynchronization therapy, coronary bypass procedures, valve repairs/replacement procedures, percutaneous coronary interventions, heart transplants, as well as implantable heart assist devices.

For patients with end-stage heart failure, the options generally are a transplant or a heart-assist device. The implantable heart-assist devices, sometimes referred to as ventricular-assist devices (VAD), serve as a “helping hand” when the heart just cannot pump the blood to the body effectively. This device may be inserted:

• To bridge the gap to when a patient can get a heart transplant (bridge to transplant)
• To provide long-term support for a patient who is too sick to receive a heart transplant (destination therapy)
• To allow the heart to rest and recover its normal function

There are approximately 4,000 people on a waiting list for a heart transplant and many will die waiting. The VAD can provide a valuable alternative. VADs can either be right sided (RVAD) or left sided (LVAD), with the LVAD being much more common, as left heart failure is the most common cause of heart failure.

VADs can be either implantable heart assist systems or short-term external heart assist systems. Common brand names of the devices are HeartMate II® and Impella®. Although systems can vary in their components the general system is made up of an implanted pump unit, a controller, and a power supply (battery and/or AC/DC adapter for an outlet or car).

The LVAD does not replace the heart but rather receives blood from the left ventricular and “assists” by passing that blood along to the aorta.

These ICD-10-PCS codes are assigned from PCS table 02H:

For FY 2018, a specific device character has been created to distinguish “short-term” or temporary external heart assist devices used intraoperatively or for a short time frame (up to 30 days) to support the right and/or left heart.

This short-term device is used for those with acute heart failure while longer term options are being considered. It can also be used for patients for post-cardiotomy recovery in patients who cannot be weaned off cardiopulmonary bypass. It can be used as a RVAD for patients with cardiogenic shock due to acute right ventricular heart failure. Some devices can be placed percutaneously via catheters and others may require open heart surgery.

One of the most fascinating things about patients with LVADs is that they do not have a pulse. For a patient who necessitates resuscitation, it can be a challenge because the provider may have to listen for the mechanical “whirring sound” to determine if the device is working. If the device is clearly working, then diagnostic procedures like cardiac monitoring, Doppler blood pressures, and echocardiograms are used.

Of the more than 6 million patients living with heart failure, advances in medical technology provide many options to manage the symptoms and return the patient to a relatively normal life. This life-saving device enables end-stage heart failure patients the ability to travel by land, sea, and even air. I’m not sure I’ll ever look at the highly coveted power outlets in an airport the same way again wondering if someone needs that outlet to “charge their heart” rather than my cell phone.

Editor’s note: This article originally appeared in JustCoding. McCall is the director of HIM and coding for HCPro in Middleton, Massachusetts, and oversees all of the Certified Coder Boot Camp programs. McCall works with hospitals, medical practices, and other healthcare providers on a wide range of coding-related custom education sessions. Contact her at smccall@hcpro.com. For more information, see www.hcprobootcamps.com.