Download Left Ventricular Failure (LVF) with past history of congestive cardiac

LEFT VENTRICULAR FAILURE (LVF) WITH PAST HISTORY OF
CONGESTIVE CARDIAC FAILURE (CCF)
BACKGROUND
When LVF is consistently documented in progress notes and on the discharge summary, yet
there is mention of CCF in the past history, should coders use I50.1 (LVF) or I50.0 (CCF
secondary to LVF)?
There are no standards or firm rules on this. Furthermore, the consistency and extent of the
documentation with regard to past history, across all hospitals, will be variable. Therefore
this is left primarily to the judgement of coders in individual cases. In making that judgement
however, some of the following points may be useful:
Aetiology and Chronicity
In Western populations left ventricular failure (LVF) is the predominant aetiology in heart
failure. Left sided failure is associated with the most common lifestyle diseases (coronary
artery disease and hypertension). Right sided failure (CCF) is most often secondary to LVF
and is an indication of the chronic progression of LVF. Therefore in most people a past
medical history of CCF in a patient with current LVF will indicate a degree of chronic heart
failure. This will not be true of all cases however.
Firstly, all heart failure can be acute or chronic and a current episode of LVF does not
preclude a previous acute episode of CCF. In some people CCF can also develop as the
primary aetiology in its own right. For example, in inferior infarcts, CCF may develop without
pulmonary oedema. In such patients CCF can resolve, does not necessarily bear any
relation to LVF and is not necessarily chronic.
In summary, the assumption of chronicity for a past medical history of CCF will be correct
most, but not all of the time.
The viewpoint of the clinician currently responsible for care
Coding strictly to what is currently documented preserves the clinician’s right to dissent from
or revise previous diagnoses. Clinicians may have varying levels of confidence in the veracity
of previous diagnoses. The omission of a previously documented condition is not always
negligence on the part of the clinician, but may be indicative of a revised or dissenting
opinion.
Research gains and losses
In routinely assigning I50.0 where any past history of CCF is documented, the researcher
gains from the coder a fuller picture of the extent of chronic progression of heart failure.
However Australian Coding Standards increasingly place emphasis on destabilisation of
chronic conditions. Stable LVF/CCF is not coded at all. When such a patient destabilises
the ability to use either I50.1 or I50.0, depending on circumstances allows the coder to show
the extent of cardiac decompensation at this episode.
AUSTRALIAN CODING STANDARDS
0920
ACUTE PULMONARY OEDEMA CMC
When 'acute pulmonary oedema' is documented without further qualification about the underlying
cause, assign code I50.1 Left ventricular failure. [1][1]
CODING MATTERS
Heart failure I50
Congestive heart failure (CHF/CCF) is a syndrome in which the heart is unable to pump at an adequate rate for the body's
metabolic requirements. This causes signs and symptoms of volume overload or manifestations of impaired tissue perfusion
such as oedema, fatigue and decreased exercise tolerance. It is not necessary to code volume (fluid) overload in a patient
with CHF.
Heart failure usually begins with the left ventricle not working efficiently (left ventricular failure –LVF), which results in
congestion of the lungs. Assign I50.1 Left ventricular failure.
Failure of the pumping action of the right ventricle (right ventricular failure) is most commonly caused by prior left ventricular
failure and results in congestion in veins and capillaries around the body. Therefore, if both LVF and CHF are documented,
only I50.0 Congestive heart failure is assigned.
Acute pulmonary oedema (APO) is a life-threatening manifestation of acute left ventricular failure secondary to sudden
onset of pulmonary venous hypertension forcing fluid out of the pulmonary veins and into the pleural cavity (pleural
effusion). If it is documented that the patient has APO and CHF, assign only I50.0 Congestive heart failure (see also ACS
0920 Acute pulmonary oedema). It is not necessary to code pleural effusion unless specific treatment (eg drainage) is
[2][2]
required.
S:\HMDC\Coding Education team\Education_Back to Basics_LVF with background of CCF_Tracey Jamieson
June2009