Medical Coding for Congestive Heart Failure Diagnosis and Management

Medical Coding for Congestive Heart Failure Diagnosis and Management CHF occurs when the heart fails to pump blood around the body properly. Learn more about the causes, treatment and medical codes related to this condition.

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Congestive heart failure (CHF) is a common condition affecting more than 6 million Americans. This chronic progressive condition occurs when your heart muscles are unable to pump enough blood as they normally should, resulting in swelling, shortness of breath, and other issues. Often known as “heart failure”, CHF specifically refers to the stage where the heart muscles become too weak or stiff resulting in fluid build-up around the heart which causes it to pump inefficiently. It develops when your ventricles can’t pump enough blood volume to the body. This eventually may result in blood and other fluids to build-up inside your lungs, liver, abdomen and lower body. CHF can be life-threatening. It is always not possible to reverse the complications or conditions that lead to heart failure. However, correct and early administration of treatment modalities can help improve the immediate signs and symptoms of heart failure and help people live longer. Bringing in vital lifestyle changes such as regular body exercise, reducing body weight, consuming a healthy diet and managing stress can help reduce the severe complications of CHF and improve the quality of the patient’s life. Cardiology medical billing and coding is highly complex and you need to follow several rules related to reporting the treatment and diagnosis procedures accurately. Cardiologists or other specialists need to correctly document the procedures performed in the patient’s medical chart. Medical coding outsourcing is a practical option physicians could utilize to simplify their documentation process.

CHF does not mean that your heart has completely stopped working. Rather, it just needs some extra support to help it work better. Reports suggest that roughly 670,000 people are diagnosed with heart failure each year in the United States. The condition can occur at any age and is a leading cause of hospitalization in older people aged 65 years and above.

Types of Heart Failure and Causes One of the most common types of heart failure is Left-sided CHF which occurs when your left ventricle doesn’t pump blood properly out to your body. As the condition progresses, fluid can build up in your lungs, which makes breathing difficult. There are two kinds of left-sided heart failure namely  

Systolic heart failure - occurs when the left ventricle fails to contract normally.

Diastolic failure, or diastolic dysfunction - occurs when the muscle in the left ventricle becomes stiff.

Heart failure is often the result of a number of other conditions that damage the heart muscles at the same time including - coronary artery disease, hypertension, cardiomyopathy, valve conditions, heart rhythm problems (arrhythmias), congenital heart disease and other conditions such as diabetes, thyroid disease, and obesity. In addition, anemia, excessive alcohol consumption and an overactive thyroid can also lead to this condition.

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Diagnosing the Symptoms and Treatment Modalities for CHF In most cases, CHF can be ongoing (chronic), or may start suddenly (acute). The symptoms may at times be mild to severe. In other cases, these can be constant or can come and go. The symptoms may include          

Dizziness, fatigue, and weakness Rapid or irregular heartbeats Fluid and water retention Congested lungs Fainting Chest pain that radiates through the upper body Reduced ability to exercise Persistent cough or wheezing with white or pink blood-tinged phlegm Increased need to urinate at night Lack of appetite and nausea

If you experience any of the above symptoms that may point to a severe heart condition, it is important to seek immediate medical attention. Diagnosis of this heart condition may generally begin with a detailed physical exam (will involve listening to your heart with a stethoscope to detect abnormal heart rhythms), review of previous medical history and immediate symptoms. Cardiologists will also check for the presence of risk factors such as high blood pressure, coronary artery disease or diabetes. Several diagnostic imaging tests such as - Electrocardiogram (ECG), Echocardiogram, Chest Xray, Cardiac computerized tomography (CT) scan, Magnetic resonance imaging (MRI), Coronary angiogram, Myocardial biopsy, stress test and blood tests (to check for a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP) may be conducted to diagnose the condition.

Treatment modalities for CHF may mainly depend on the underlying causes and symptoms. A combination of medications including - Angiotensin-converting enzyme (ACE) inhibitors, Beta Blockers, Angiotensin II receptor blockers, Diuretics, Aldosterone antagonists, Inotropes, Digoxin (Lanoxin) will be prescribed to treat this condition effectively.

If medications aren’t effective on their own, cardiologists may recommend surgical procedures to treat the underlying problem that led to heart failure. Angioplasty is a common procedure done to open up blocked arteries. Other procedures include Coronary bypass surgery, Heart valve repair or replacement, Implantable cardioverterdefibrillators (ICDs), Cardiac resynchronization therapy (CRT), or biventricular pacing, ventricular assist devices (VADs) and heart transplant.

Cardiologists or other heart specialists who offer specialized treatment for CHF need to be adequately reimbursed for the services rendered to the patients. Correct medical codes must be used to document the diagnosis, screening and other procedures www.outsourcestrategies.com

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performed. Medical billing and coding services offered by reliable medical billing companies could prove useful for providers. The ICD-10 codes relevant to congestive heart failure (CHF) include I50 - Heart failure 

I50.1 - Left ventricular failure, unspecified

I50.2 - Systolic (congestive) heart failure    

I50.20 - Unspecified systolic (congestive) heart failure I50.21 - Acute systolic (congestive) heart failure I50.22 - Chronic systolic (congestive) heart failure I50.23 - Acute on chronic systolic (congestive) heart failure

I50.3 - Diastolic (congestive) heart failure    

I50.30 - Unspecified diastolic (congestive) heart failure I50.31 - Acute diastolic (congestive) heart failure I50.32 - Chronic diastolic (congestive) heart failure I50.33 - Acute on chronic diastolic (congestive) heart failure

I50.4 - Combined systolic (congestive) and diastolic (congestive) heart failure    

I50.40 - Unspecified combined systolic (congestive) and diastolic (congestive) heart failure I50.41 - Acute combined systolic (congestive) and diastolic (congestive) heart failure I50.42 - Chronic combined systolic (congestive) and diastolic (congestive) heart failure I50.43 - Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure

I50.8 - Other heart failure I50.81 - Right heart failure         

I50.810 - Right heart failure, unspecified I50.811 - Acute right heart failure I50.812 - Chronic right heart failure I50.813 - Acute on chronic right heart failure I50.814 - Acute on chronic right heart failure, due to left heart failure I50.82 - Biventricular heart failure I50.83 - High output heart failure I50.84 - End stage heart failure I50.89 - Other heart failure

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I50.9 - Heart failure, unspecified

The risk of congestive heart failure (CHF) may increase due to several factors like genetics, obesity, high blood pressure, diabetes and the use of certain medications. But, apart from these risk factors, lifestyle factors may also play a prominent role. Therefore, incorporating key lifestyle changes like - maintaining a well-balanced diet, practicing regular body exercise, monitoring your body weight, reducing the intake of alcohol and fluids, stopping the habit of smoking, reducing stress and keeping yourself active may help relieve signs and symptoms of heart failure and or at least delay onset.

Coding for CHF can be challenging. For correct and timely medical billing and claims submission, healthcare practices can outsource their medical coding tasks to a reliable medical billing and coding company that provides the services of AAPC-certified coding specialists.

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