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2025 ICD-10-CM code I50.84

End-stage heart failure (Stage D).

Code I50.84 should be used in conjunction with a code specifying the type of heart failure (e.g., I50.2x for systolic heart failure) if known.

Medical necessity for the services provided to a patient with end-stage heart failure should be well-documented. This includes justification for medications, procedures, and supportive care, emphasizing the severity of the condition and the need for ongoing management.

Diagnosis and management of end-stage heart failure typically fall under the purview of cardiology, often involving palliative care specialists as the disease progresses.

In simple words: This code signifies the most advanced stage of heart failure, where the heart is severely weakened and unable to pump enough blood to meet the body's needs, even with medication.

End-stage heart failure represents the final stage (Stage D) of heart failure, characterized by severe symptoms at rest despite optimal medical therapy.It is crucial to also code the specific type of heart failure (systolic, diastolic, or combined) if known (I50.2-I50.43).

Example 1: A patient with a long history of heart failure presents with severe shortness of breath and fluid retention despite maximal medical therapy. The patient is now bedridden and requires supplemental oxygen. This scenario qualifies for I50.84, along with a code specifying the type of heart failure., A patient experiences worsening heart failure symptoms, including fatigue, chest pain, and shortness of breath, despite treatment. Advanced imaging and clinical assessment reveal markedly reduced cardiac function, characterizing end-stage heart failure., A patient on the heart transplant list due to severe heart failure develops refractory fluid overload and is placed on continuous intravenous inotropic support. This situation qualifies as end-stage heart failure.

Documentation should clearly state "end-stage heart failure" or "Stage D heart failure." It should also include details about the underlying type of heart failure (systolic, diastolic, or combined) if known. Supporting documentation should demonstrate the patient's symptoms, functional limitations, and refractoriness to medical therapy.

** It is essential to differentiate end-stage heart failure (I50.84) from other stages of heart failure for accurate coding and reimbursement.Ensure thorough documentation supports the severity and progression of the disease.

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