2025 ICD-10-CM code I50.4
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the circulatory system - Heart failure Diseases of the circulatory system (I00-I99) Feed
Combined systolic and diastolic heart failure.
Modifiers may be applicable depending on the circumstances of service delivery.Consult the appropriate modifier guidelines for further clarification.
Medical necessity for coding I50.4 is established by documentation of clinical findings consistent with combined systolic and diastolic heart failure.This requires objective evidence of both systolic and diastolic dysfunction, supported by clinical examination and appropriate diagnostic testing.The severity of the condition and the need for treatment must be clearly documented.
The clinical responsibility for diagnosing and managing I50.4 involves a comprehensive evaluation by a cardiologist or other qualified healthcare professional. This includes obtaining a detailed patient history, conducting a physical examination, and ordering appropriate diagnostic tests such as echocardiography, electrocardiography, and blood tests.Treatment strategies depend on the severity and underlying causes of heart failure and may involve lifestyle modifications, medications, and potentially surgical interventions.
In simple words: This code means the heart isn't pumping blood well because it's not squeezing hard enough (systolic failure) and not relaxing enough (diastolic failure) to fill with blood properly. This can be a sudden problem or a long-term one.
This code signifies combined systolic (congestive) and diastolic (congestive) heart failure.It indicates the heart's inability to pump blood effectively due to impairments in both the systolic (contraction) and diastolic (relaxation) phases of the cardiac cycle. This condition can manifest acutely or chronically, and further specification with fifth-digit codes (e.g., I50.40, I50.41, I50.42, I50.43) clarifies the presentation as unspecified, acute, chronic, or acute on chronic.
Example 1: A 70-year-old patient presents with shortness of breath, fatigue, and lower extremity edema.Echocardiography reveals reduced ejection fraction and impaired diastolic function, consistent with I50.4. The patient's history includes hypertension and coronary artery disease., A 65-year-old patient with a history of hypertension experiences sudden onset of severe shortness of breath and chest pain. Diagnostic workup reveals acute combined systolic and diastolic heart failure (I50.41)., A 55-year-old patient with long-standing hypertension and diabetes develops progressive shortness of breath and edema over several months.Evaluation confirms chronic combined systolic and diastolic heart failure (I50.42).
Comprehensive documentation should include the patient's symptoms (e.g., dyspnea, fatigue, edema), physical examination findings (e.g., rales, jugular venous distension), results of diagnostic tests (e.g., echocardiography, electrocardiography, blood tests), and the treatment plan.Specific documentation of systolic and diastolic dysfunction is crucial for accurate coding.
** Consider using additional codes to specify the etiology of heart failure (e.g., hypertension, coronary artery disease) when appropriate.Always refer to the most recent official ICD-10-CM coding guidelines for precise code application.
- Payment Status: Active
- Specialties:Cardiology, Internal Medicine
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Emergency Room - Hospital