PIVOT Points

Code the scenario in ICD-9:

Rationale:

• The physician specified the diagnosis as acute on chronic systolic heart failure and thus 428.23 is the most appropriate code for M1020.
• A second code, 428.0, must be added to capture that she also has a diagnosis of congestive heart failure.
• The physician did not state that the patient’s hypertension caused the heart failure. Thus, it is appropriately captured with the 401 series (Essential hypertension) and not the 402 series (Hypertensive heart disease).
• Her long-term use of anticoagulant medication is captured with V58.61.
• Though her shortness of breath is a major component of her care, it is considered integral to a diagnosis of heart failure and is therefore not coded separately.

Code the scenario in ICD-10:

Rationale:

• Only one code, I50.23, is required to capture both the acute on chronic systolic heart failure and the congestive heart failure.
• Note the level of specificity available to capture atrial fibrillation in ICD-10. Where ICD-9 offers only one code for this condition (427.31), the ICD-10 category I48.- (Atrial fibrillation and flutter) offers four different subtypes (paroxysmal, persistent, chronic and unspecified).