2025 ICD-10-CM code I50.40
(Active) Effective Date: N/A Revision Date: N/A Diseases of the circulatory system - Unspecified combined systolic (congestive) and diastolic (congestive) heart failure Diseases of the circulatory system (I00-I99) Feed
Unspecified combined systolic and diastolic heart failure.
Modifiers may be applicable depending on the circumstances of the encounter and the services provided.Consult official modifier guidelines.
Medical necessity for coding I50.40 is established by the presence of clinical findings consistent with heart failure, including symptoms and objective evidence of both systolic and diastolic dysfunction obtained through appropriate diagnostic testing.The severity of symptoms and impairment in cardiac function must support the need for treatment and ongoing medical management.
The clinical responsibility involves diagnosing and managing heart failure, including assessing symptoms, performing physical examinations, ordering and interpreting diagnostic tests (e.g., echocardiogram, BNP levels), and developing a treatment plan which may include lifestyle modifications, medications (e.g., ACE inhibitors, beta-blockers, diuretics), and possibly device therapy (e.g., pacemakers, ICDs).
In simple words: This code means the patient has a type of heart failure where both the pumping and filling functions of the heart are affected, but the doctors don't have enough information to specify exactly how.
This ICD-10-CM code classifies unspecified combined systolic (congestive) and diastolic (congestive) heart failure.It indicates the presence of both systolic and diastolic dysfunction, but the specific type and severity are not specified.This code is used when there is insufficient information to assign a more specific code within the I50.4 category.
Example 1: A 70-year-old patient presents with shortness of breath, fatigue, and edema.Echocardiogram reveals both reduced ejection fraction and impaired diastolic filling.The physician diagnoses unspecified combined systolic and diastolic heart failure (I50.40)., A 65-year-old patient with a history of hypertension is admitted with worsening heart failure.Diagnostic testing shows evidence of both systolic and diastolic dysfunction.The primary diagnosis is hypertension with heart failure, but I50.40 is also coded to further specify the type of heart failure., A patient presents with symptoms suggestive of heart failure, but further diagnostic testing is inconclusive regarding the precise nature of systolic versus diastolic dysfunction.In this case of diagnostic uncertainty, I50.40 is the appropriate code to use.
Detailed history and physical examination findings, including symptoms (e.g., dyspnea, fatigue, edema), vital signs, and results of diagnostic tests (e.g., echocardiogram, cardiac biomarkers, chest X-ray).
** This code is for use when there is insufficient information to specify the type of heart failure more precisely.Always strive to use the most specific code possible based on available clinical documentation.
- Payment Status: Active
- Modifier TC rule: Not applicable to this diagnosis code.
- Specialties:Cardiology, Internal Medicine, Family Medicine
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Emergency Room - Hospital,Urgent Care Facility,Skilled Nursing Facility