Dr. Oubre's Digest

Read time: 2.5 minutes

What should you call heart failure? 

Systolic and Diastolic? HFrEF & HFpEF? 

The answer might surprise you. 

The problem?

• There are "new" classifications of heart failure.

• But ICD10 Coding is outdated.

• But those codes dictate how you get "credit"

• Many believe they can't use these newer classifications in their documentation.

But don't worry. There's good news. 

1 / The "New" Classifications

• HF with reduced EF (HFrEF): LVEF <40%

• HF with preserved EF (HFpEF): LVEF >50%

• HF with mildly reduced EF (HFmrEF): LVEF 41 - 49%

• HF with improved EF (HFimpEF): LVEF <40% + >10 pt increase from baseline, with second >40%

These are based on the universal definition and classification of heart failure released in 2021 (they were described before then). But... coding hasn't caught up. So what does coding use?

2 / Coding Rules for Heart Failure
These are based on Acuity and Type.

1. Acuity

   • Acute

   • Chronic

   • Acute on Chronic

2. Type

   • Systolic

   • Diastolic

   • Combined Systolic and Diastolic

Note the difference: Reduced EF & Persevered EF rather than Systolic & Diastolic. 

The new universal definition also prefers "decompensated" or "exacerbation" rather than "acute on chronic." 

But there's good news! Coders convert them. 

• Decompensated = Exacerbation = Acute on Chronic

• HFrEF or HFmrEF = Systolic

• HFpEF = Diastolic

So, you can still use these! HFimpEF will probably result in a query though. 

3 / Heart Failure Documentation Pitfalls

• Don't just document EF. You must document systolic, HFrEF, etc. If you don't, you'll get a query or not get credit.

• "CHF" is doubly outdated and gets you NO credit (not an CC or MCC)

• Do not use "dysfunction" as a substitute for "failure." It does not mean the same thing and gets you no credit. 

In Summary

1.    You don't have to use "systolic" or "diastolic"

2.    You can use HFpEF, HFrEF, HFmrEF. Coders convert them!

3.    But don't only document the EF. You must specify type. 

4.    Documenting acuity will prevent a query. 

5.    PLEASE stop using "CHF!"

Question / Answer

Who are these "coders?"

Your hospital employs inpatient coders that convert your documentation to ICD10 codes (so you don't have to). 

What are quality impacts?

CMS monitors 30-day readmission and mortality rates for heart failure and these rates are available on CMS Hospital Compare reports. 

What about BNP vs NT-proBNP?

These are natriuretic peptides that can be measured to improve diagnostic accuracy and guide risk stratification in patients with heart failure. However, in patients with HFpEF or obesity, these peptides can be lower than those with HFrEF.

Note that BNP is a substrate for neprilysin. So, the use of Angiotensin receptor-neprilysin inhibitors (such as Entresto) may result in an increase in BNP levels but NOT NT-proBNP. Therefore, this may not be a reliable marker for an exacerbation in this setting.