THE ANATOMY OF CONGESTIVE HEART FAILURE
In a normally functioning heart, oxygen-poor blood enters the right side of the heart through the inferior and superior vena cava and enters the right atrium. As the atrium contracts, blood flows from the right atrium into the right ventricle through the open tricuspid valve.
When the ventricle is full, the tricuspid valve closes to prevent blood from flowing back into the right atrium when the ventricle contracts. As the ventricle contracts, blood leaves the heart through the pulmonic valve, into the pulmonary artery and to the lungs where it is oxygenated.
On the left side of the heart the pulmonary vein empties oxygen-rich blood from the lungs into the left atrium of the heart. As the atrium contracts, blood flows from the left atrium into the left ventricle through the open mitral valve.
When the ventricle is full, the mitral valve closes to prevent blood from flowing back into the left atrium when the ventricle contracts. As the ventricle contracts, oxygen-rich blood leaves the heart through the aortic valve, into the aorta and to the arteries, then into the veins.
However not all hearts function at optimal levels. Congestive heart failure occurs when the heart isn’t able to pump enough blood to meet the needs of the body. This results in a decrease in blood supply to the body tissue which leads to a decrease in oxygen and a failure to meet other metabolic requirements.
When this happens, less blood is being filtered by the kidneys which results in less fluid being circulated into urine. The extra fluid in circulation can build up in the lungs, the liver, around the eyes, and in the legs and result in pulmonary and/or circulatory congestion.
Symptoms of congestive heart failure can be shortness of breath, fatigue, edema in legs/ankles/feet, persistent cough or wheezing, rapid weight gain from fluid retention and chest pains.
The two most common causes of heart failure are:
While coronary artery disease and hypertension attribution to the most common causes, other heart conditions that can cause or contribute to heart failure include:
DIAGNOSING CONGESTIVE HEART FAILURE
Congestive heart failure can be diagnosed with the use of one or more of the following diagnostic studies:
What is Ejection Fraction?
The measurement of ejection fraction is often used to aid in diagnosing congestive heart failure. Ejection fraction is a measurement of the percentage of blood leaving your heart each time it contracts. The ejection fraction is usually measured only in the left ventricle. The left ventricle is the heart’s main pumping chamber.
Types of Congestive Heart Failure
There are three main types of congestive heart failure – systolic heart failure, diastolic heart failure & a combination of systolic and diastolic heart failure.
Heart failure is differentiated by whether it affects the right or left ventricle.
CODING CONGESTIVE HEART FAILURE
All codes for heart failure include any associated pulmonary edema – no additional code is assigned.
Code assignment may be based on documentation of HFrEF (heart failure with reduced ejection fraction) or HFpEF (heart failure with preserved ejection fraction).
When a patient has a known history of diastolic or systolic congestive heart failure, a code for chronic heart failure is assigned:
Heart dysfunction without mention of heart failure: It is not appropriate to assume the patient is in heart failure if only “diastolic dysfunction” or “systolic dysfunction” is documented. This takes us to I51.89, Other ill-defined heart diseases. In this case, you should query physician for clarification.
HYPERTENSIVE HEART DISEASE AND HEART FAILURE
ICD-10-CM presumes a causal relationship between hypertension and heart involvement. The two conditions are linked by the term “with” in the Alphabetic Index. They should be coded as related even if the physician documentation does not explicitly link them. One exclusion would be: physician documentation that clearly states the hypertension is unrelated to the heart disease or another cause is identified.
Hypertension with heart conditions classified to I50.- or I51.4 – I51.7, I51.89, I51.9 are assigned to a code from category I11, Hypertensive heart disease. Use additional code(s) from category I50, Heart failure, to identify the type(s) if heart failure.
Author: Sandy Hall, CCS, COC, CPC