2025 ICD-10-CM code I50

Heart failure

Code first any underlying conditions that contribute to the heart failure, such as hypertension (I11.0) or coronary artery disease.Use additional codes to specify the type of heart failure (e.g., systolic, diastolic) or any associated conditions.

Medical necessity for heart failure treatment is established by the presence of signs, symptoms, and diagnostic findings consistent with the condition. The documentation should clearly link the diagnosis of heart failure to the patient's presenting complaints and the need for medical intervention to improve heart function, alleviate symptoms, and prevent complications.Specific payer guidelines may apply.

Diagnosis and management of heart failure typically falls under the purview of cardiology, internal medicine, or family medicine.Responsibilities include evaluating the underlying cause, assessing the severity, and developing a treatment plan to improve heart function and alleviate symptoms. This often involves prescribing medications, recommending lifestyle changes, and monitoring the patient's progress.

In simple words: Heart failure is a condition where the heart can't pump enough blood to meet the body's needs.It doesn't mean the heart has stopped beating, but it's not working as efficiently as it should.

A heterogeneous condition in which the heart is unable to pump out sufficient blood to meet the metabolic needs of the body. Heart failure can be caused by structural defects, functional abnormalities (ventricular dysfunction), or a sudden overload beyond its capacity. Chronic heart failure is more common than acute heart failure, which results from a sudden insult to cardiac function, such as a myocardial infarction.

Example 1: A 65-year-old patient with a history of coronary artery disease presents with shortness of breath, fatigue, and swollen ankles. After diagnostic testing, including an echocardiogram, they are diagnosed with heart failure., A patient with long-standing uncontrolled hypertension develops progressive shortness of breath and is found to have heart failure due to left ventricular hypertrophy., Following a myocardial infarction, a patient experiences a decline in heart function and is diagnosed with acute heart failure.

Documentation should include the type of heart failure (e.g., systolic, diastolic, left-sided, right-sided), the underlying cause (if known), the severity (e.g., New York Heart Association functional classification), and any associated conditions.Relevant diagnostic test results, such as echocardiograms, electrocardiograms, and blood tests, should also be documented.

** The leading causes of heart failure are coronary artery disease, high blood pressure, and diabetes. Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation.

  • Payment Status: Active
  • Specialties:Cardiology, Internal medicine, Family medicine
  • Place of Service:Inpatient Hospital, Office, Outpatient Hospital, Emergency Room - Hospital,Home, Skilled Nursing Facility, Hospice
** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.