Coding for Heart Failure in Home Health

Posted on Thursday, April 20, 2017 2:38 PM

Recently, there has been a lot of talk concerning heart failure (CHF) in home health and Coding Clinic addressed a few changes in their first quarter release this year.

Systolic and/or diastolic dysfunction is commonly assumed as related to CHF. But, the fact is that we shouldn’t be making that assumption. Documentation is the key to successfully coding CHF. Set standards in your agency to request additional information when only CHF is documented.

In the presence of HTN, systolic/diastolic dysfunction is assumed as HTN heart disease (since systolic/diastolic dysfunction falls under conditions in I51.4-I51.9 due to hypertension). But, we should not be considering it the same as heart failure. When both CHF and systolic dysfunction are documented, you are allowed to code systolic heart failure only if the physician links these two conditions. If no link is available, query the physician.

Written by Mary Deakle, BCHH-C, COS-C, Manager of Compliance and Education

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