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ICD-10 Guide
ICD-10 CodesI50.813

I50.813

Billable

Acute on chronic right heart failure

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 I50.813 is a billable code used to indicate a diagnosis of acute on chronic right heart failure.

Key Diagnostic Point:

Acute on chronic right heart failure (CHF) is a complex cardiovascular condition characterized by the sudden exacerbation of chronic right heart failure symptoms. Clinically, patients may present with signs of fluid overload, such as peripheral edema, jugular venous distension, and ascites, alongside symptoms of dyspnea and fatigue. The anatomy involved primarily includes the right ventricle, pulmonary arteries, and systemic venous return pathways. Disease progression often involves a history of chronic pulmonary hypertension, left heart failure, or valvular heart disease, which can lead to right ventricular dysfunction over time. Diagnostic considerations include echocardiography to assess right ventricular size and function, BNP levels to evaluate heart failure severity, and imaging studies to rule out pulmonary embolism or other acute causes. Management typically requires hospitalization for diuretics, oxygen therapy, and possibly inotropic support, emphasizing the need for careful monitoring and adjustment of treatment plans based on patient response.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive assessment of both acute and chronic heart failure components.
  • Treatment complexity: Involves multiple therapeutic strategies and close monitoring.
  • Documentation requirements: Detailed clinical documentation is essential to justify the diagnosis.
  • Coding specificity: Requires precise coding to differentiate from other heart failure types.

Audit Risk Factors

  • Common coding errors: Misclassification of acute versus chronic heart failure.
  • Documentation gaps: Incomplete clinical notes that do not capture the severity or duration of symptoms.
  • Billing challenges: Potential denials due to insufficient evidence of acute exacerbation.

Specialty Focus

Medical Specialties

Cardiology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Pulmonology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

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CPT Code

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CPT Code

Clinical Scenario

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Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Acute on chronic right heart failure significantly impacts clinical outcomes and healthcare utilization. It is associated with increased hospital admissions, longer lengths of stay, and higher healthcare costs. Understanding the epidemiology of this condition is crucial, as it affects a substantial portion of the aging population, contributing to morbidity and mortality rates. Quality measures often focus on timely intervention and management strategies to improve patient outcomes and reduce readmission rates.

ICD-9 vs ICD-10

Acute on chronic right heart failure significantly impacts clinical outcomes and healthcare utilization. It is associated with increased hospital admissions, longer lengths of stay, and higher healthcare costs. Understanding the epidemiology of this condition is crucial, as it affects a substantial portion of the aging population, contributing to morbidity and mortality rates. Quality measures often focus on timely intervention and management strategies to improve patient outcomes and reduce readmission rates.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the medical necessity for hospitalization and acute treatment is clearly documented. Common denials may arise from insufficient evidence of acute symptoms or lack of detailed treatment plans. Best practices include maintaining clear and comprehensive clinical notes and ensuring that all relevant diagnostic tests are documented and linked to the diagnosis.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by I50.813?

I50.813 covers acute exacerbations of chronic right heart failure, which may be due to underlying conditions such as chronic obstructive pulmonary disease (COPD), pulmonary hypertension, or left heart failure. It is crucial to document the chronic nature of the heart failure and the acute episode to support this diagnosis.

When should I50.813 be used instead of related codes?

I50.813 should be used when there is a clear documentation of chronic right heart failure with an acute exacerbation. If the patient presents with only chronic heart failure without acute symptoms, then I50.9 or I50.1 may be more appropriate.

What documentation supports I50.813?

Documentation should include a detailed history of the patient's chronic heart failure, recent changes in symptoms, results from diagnostic tests (like echocardiograms or BNP levels), and treatment plans that reflect the acute management of the exacerbation.