headshot of Karen Newhouser
Blog April 7, 2016

By Karen Newhouser, RN, BSN, CCM, CCDS, CCS, CDIP

Heart Failure with Preserved Ejection Fraction and Heart Failure with Reduced Ejection Fraction

For those of you who haven’t yet seen the hot-off-the-presses First Quarter 2016 Coding Clinic, it has been uploaded in Blackboard, under the Resource Center for Coding Professionals and the Resource Center for CDI Professionals.

With this communication, there is one item that I would like to call to your attention. Please see the First Quarter 2016 Coding Clinic advice on HFpEF and HFrEF below.

Heart Failure with Preserved Ejection Fraction and Heart Failure with Reduced Ejection Fraction

Coding Clinic, First Quarter ICD-10 2016 Pages: 10-11 Effective with discharges: March 18, 2016

Please reconsider the advice previously published in Coding Clinic, First Quarter 2014, page 25, stating that the coder cannot assume either diastolic or systolic failure or a combination of both, based on documentation of heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF). Would it be appropriate to code diastolic or systolic heart failure when the provider documents HFpEF or HFrEF?

Based on additional information received from the American College of Cardiology (ACC), the Editorial Advisory Board for Coding Clinic for ICD-10-CM/PCS has reconsidered previously published advice about coding heart failure with preserved ejection fraction (HFpEF), and heart failure with reduced ejection fraction (HFrEF). HFpEF may also be referred to as heart failure with preserved systolic function, and this condition may also be referred to as diastolic heart failure. HFrEF may also be called heart failure with low ejection fraction, or heart failure with reduced systolic function, or other similar terms meaning systolic heart failure. These terms HFpEF and HFrEF are more contemporary terms that are being more frequently used, and can be further described as acute or chronic.

Therefore, when the provider has documented HFpEF, HFrEF, or other similar terms noted above, the coder may interpret these as “diastolic heart failure” or “systolic heart failure,” respectively, or a combination of both if indicated, and assign the appropriate ICD-10-CM codes.

This is an important Coding Clinic because as you are aware, we have all found the need to continue to query for specificity of type concerning the diagnosis of CHF (Congestive Heart Failure) for decades, mostly due to the fact that the code descriptions haven’t kept up with the more contemporary verbiage used by providers. The terms HFpEF and HFrEF have been used regularly in documentation for several years; in fact, there was advice offered by Coding Clinic in First Quarter 2014 that addressed the use of these terms.

This has caused considerable frustration in the past between clinically oriented CDSs and the providers because they both knew they were speaking of the same condition, even though they were calling it by different names. An analogy to this is use of the terms “pop” and “soda” for the carbonated non-alcoholic beverage that we are all familiar with. We both know that we are speaking of the same liquid, yet we are requiring the other to state it our way. That would be frustrating to most people and that is what the CHF query authors have run up against for numerous years. Many are pleased that this Coding Clinic advice finally addresses the issue of the terms HFpEF and HFrEF, which is the most common vernacular used today and we thank the Editorial Advisory Board for this recent Coding Clinic.

To break down what this coding clinic is saying – effective with discharges March 18, 2016,
• When “HFpEF” or “heart failure with preserved systolic function” is documented, this verbiage means “diastolic heart failure” and the appropriate diastolic heart failure code is to be assigned.
• When “HFrEF”, “heart failure with low ejection fraction”, “heart failure with reduced systolic function”, or other similar terms meaning systolic heart failure, are documented, the appropriate systolic heart failure code is to be assigned.
• When a combination from each of the above is documented, the appropriate systolic and diastolic heart failure code is to be assigned.

You may be asking, why the excitement? The fact is, over 5 million people in the United States have the co-morbid condition of congestive heart failure http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm, and with our pledge to the patient to ensure a complete and accurate medical record, it is our responsibility to obtain clarification regarding this condition. Remember, the assignment of a code is used for much more than reimbursement. Accurate code assignment translates into precise communication across the continuum of the patient’s care, reliable data for research, valid quality metrics, judicious international tracking for public health, fastidious procedure monitoring and performance, and is a critical factor in risk adjustment methodology.

That being said, it is important to note that the acuity of the condition might still need to be ascertained in selective circumstances. In ICD-10-CM, both “unspecified” and “chronic” (systolic and/or diastolic) heart failures are CCs; therefore, it is the facility’s decision whether to query for the word “chronic” for more specificity.
Of course, if the clinical indicators for “acute” heart failure are present, a query should be considered, but once again, you should follow your facility’s guidelines.

In closing –
HFpEF = diastolic heart failure
HFrEF = systolic heart failure

I thank you for your continued positive impact in health care – and the patient thanks you as well!