Q&A: Coding the term “exacerbated” and linking systolic dysfunction with CHF

Q: I’ve heard that “exacerbated” can't be used to code acute-on-chronic congestive heart failure (CHF). Coding Clinic, however, states that it can be used. Can you clarify?

I’ve also heard that best practice is not to link diastolic dysfunction with CHF. The Coding Clinic, First Quarter, 2009, says it's okay to link systolic dysfunction with CHF, however. Wouldn’t this be the same for diastolic dysfunction?

A: Under Coding Clinic advice from 2008, the term “decompensated” indicates an acute phase of a chronic condition. However, under ICD-10-CM heart failure codes the term “decompensated” as synonymous with “acute-on-chronic.” Furthermore, while most clinicians also consider the term “exacerbated” to be synonymous with “acute-on-chronic” as well, Coding Clinic neglected to address this terminology leading to concerns related to denials.

Coding Clinic, First Quarter, 2009 (p. 7) asked, “Is a diagnosis of systolic or diastolic dysfunction coded the same as heart failure?” and they answered that no, diastolic dysfunction without mention of heart failure is indexed to 429.9 Heart disease, unspecified (which translates to I51.8 in ICD-10-CM) it is not appropriate to assume a patient is in heart failure when only “diastolic dysfunction” or “systolic dysfunction” is documented.

There is no code within the ICD-10-CM code set for diastolic dysfunction. When you look up dysfunction, heart in the alphabetic index it leads to I51.89 Other ill-defined heart disease and likely the use of the diastolic heart failure code applied to documentation of the term dysfunction would be denied.

Editor’s Note: Sharme Brodie RN, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com/courses/10040/overview.