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2025 ICD-10-CM code I50.9

Heart failure, unspecified.

Code first any underlying conditions contributing to the heart failure, such as hypertension (I11.0) or ischemic heart disease (I25.9).

Medical necessity for I50.9 requires the presence of clinical signs and symptoms of heart failure. If the type of heart failure is identified through further investigation, the code should be updated accordingly.

Physicians use this code to document a diagnosis of heart failure when the specific type is not specified in the medical record. It’s crucial for physicians to document the underlying cause, type, and any associated conditions for accurate coding and optimal patient care. They should strive for more specific diagnoses whenever possible, instead of using this unspecified code.

IMPORTANT:If the type of heart failure is known, use more specific codes such as I50.1 (Left ventricular failure), I50.20 (Unspecified systolic (congestive) heart failure), I50.30 (Unspecified diastolic (congestive) heart failure), I50.40 (Unspecified combined systolic and diastolic heart failure), I50.81 (Right heart failure), I50.82 (Biventricular heart failure).

In simple words: This code indicates a general diagnosis of heart failure, where the doctor hasn't specified what kind of heart failure it is. It means the heart isn't pumping blood as well as it should, but the medical records don't give enough information to be more specific.

This code represents a diagnosis of heart failure where the specific type (systolic, diastolic, left-sided, right-sided, etc.) is not documented or unknown. It encompasses various forms of heart failure where the underlying cause or the specific ventricle affected is not clearly specified.

Example 1: A patient presents with shortness of breath, edema, and fatigue. The physician diagnoses heart failure, but further testing is required to determine the specific type, so I50.9 is used initially., A patient with a history of hypertension arrives at the emergency room with symptoms suggestive of heart failure. Before echocardiography results are available, the physician uses I50.9 as a preliminary diagnosis., A patient's medical record mentions heart failure without further details about the type or cause. In this case, I50.9 is appropriate for coding purposes due to the lack of specific information.

The documentation should support the diagnosis of heart failure. If the type, cause, or associated conditions are known, these should be documented and coded accordingly. If the condition is unspecified, the documentation should reflect the uncertainty in the diagnosis.

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