2025 ICD-10-CM code I50.43
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Heart Failure - Other forms of heart disease (I30-I5A) Diseases of the circulatory system (I00-I99) Feed
Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure.
Not applicable to ICD-10 codes.
Medical necessity for this diagnosis is established by the presence of signs and symptoms indicative of acute decompensation of chronic heart failure, necessitating medical intervention to prevent further deterioration and potential life-threatening complications.Documentation should support the acuity and severity of the exacerbation.
The clinical responsibility for this diagnosis includes comprehensive assessment of the patient's symptoms, cardiac function (e.g., through echocardiogram), and overall clinical status.Management might involve adjustments to medications, lifestyle modifications, and potential hospital admission for stabilization.
In simple words: This code means the patient has a long-term heart condition where the heart doesn't pump blood well (systolic) and doesn't fill with blood easily (diastolic).Recently, their heart condition has gotten much worse.
This code signifies acute decompensation superimposed on pre-existing chronic heart failure involving both systolic and diastolic dysfunction.It indicates a recent worsening of symptoms in a patient with a history of both impaired left ventricular contractility (systolic failure) and impaired ventricular filling (diastolic failure).
Example 1: A 72-year-old patient with a history of hypertension and coronary artery disease presents to the emergency department with shortness of breath, edema, and reduced exercise tolerance.Echocardiography reveals reduced ejection fraction and evidence of diastolic dysfunction.The diagnosis of I50.43 is assigned., A 68-year-old patient with known heart failure (both systolic and diastolic dysfunction) experiences a sudden worsening of symptoms, including increased dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.They are hospitalized for intravenous diuretics and inotropic support.I50.43 is the appropriate code., A 55-year-old patient with long-standing hypertension and diabetes develops acute pulmonary edema.Cardiac evaluation reveals both systolic and diastolic dysfunction, consistent with acute-on-chronic heart failure. This patient also required intubation and mechanical ventilation. I50.43 is coded.
Detailed history and physical exam, echocardiogram report, laboratory results (including electrolytes, renal function, and cardiac biomarkers such as BNP), and documentation of the acute exacerbation of symptoms, along with any interventions or treatments provided.
** This code is frequently used in conjunction with other codes to specify the underlying cause of heart failure (e.g., hypertension, coronary artery disease) and any co-morbid conditions.
- Revenue Code: Revenue codes will vary depending on the specific services rendered and the payer.
- RVU: RVUs are not directly associated with ICD-10 codes.Reimbursement is determined by the procedures performed and the payer's fee schedule.
- Global Days: Not applicable to ICD-10 codes.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes.
- Fee Schedule: Not applicable to ICD-10 codes.
- Specialties:Cardiology
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, Office, Outpatient Hospital