2025 ICD-10-CM code I50.8
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the circulatory system - Other heart failure Diseases of the circulatory system (I00-I99) Feed
Other heart failure; encompasses heart failure not specified by other I50 codes.
Modifiers may be applicable depending on the circumstances of the encounter and the services provided (e.g., place of service, type of visit).
Medical necessity for the diagnosis of heart failure (I50.8) will depend on the clinical presentation, symptoms, and supporting diagnostic findings confirming reduced cardiac function. The documentation must demonstrate the need for medical interventions and justify the diagnosis, and the physician must articulate why a more specific code could not be used.
The clinical responsibility for coding I50.8 falls upon the physician or healthcare provider who diagnoses and manages the patient's heart failure. Accurate coding requires a detailed clinical evaluation to ascertain the most precise diagnosis and characteristics of the patient's condition.This may involve reviewing patient history, conducting a physical examination, and performing diagnostic tests, such as echocardiograms or cardiac catheterization.
In simple words: This code means the heart isn't pumping blood well enough, but it's not one of the specific types of heart failure. Doctors use this code when the exact kind of heart problem isn't clearly defined.
I50.8, Other heart failure, in the ICD-10-CM classification, represents heart failure conditions that don't fit the specific criteria of other I50 codes (e.g., left ventricular failure, systolic heart failure, diastolic heart failure, or combined systolic and diastolic heart failure).It includes various forms of heart failure not otherwise categorized, requiring detailed clinical documentation to specify the precise type and characteristics of the failure.
Example 1: A 70-year-old patient presents with shortness of breath, edema, and fatigue.Echocardiogram reveals reduced ejection fraction but without specific left or right heart dominance. The provider documents "heart failure, etiology unspecified," resulting in code I50.8., A 65-year-old patient with a history of hypertension and coronary artery disease develops acute heart failure.While the systolic function is impaired, it does not meet the criteria for I50.2. The documentation clarifies the presence of right-sided heart failure, leading to the code I50.81., An 82-year-old patient is admitted for worsening dyspnea and fluid retention.The physician's examination and investigations do not pinpoint a specific type of heart failure. Extensive investigations are inconclusive, and only general heart failure is diagnosed, hence I50.8 is assigned.
Comprehensive documentation is crucial for accurate coding. This should include: detailed history and physical examination findings, echocardiogram reports (if performed), cardiac biomarkers (BNP, NT-proBNP), chest x-ray results, relevant laboratory tests, and the physician's assessment clearly stating the type and characteristics of heart failure.If the type of heart failure cannot be precisely determined, thorough explanation of the reasons for the inability to classify should be provided.
** I50.8 is a residual category, used only when sufficient documentation exists to support heart failure but the specific type cannot be determined.Additional codes may be necessary to reflect comorbidities or complications.
- Payment Status: Active
- Specialties:Cardiology, Internal Medicine, Family Medicine
- Place of Service:Inpatient Hospital, Outpatient Hospital, Emergency Room - Hospital, Office