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Coding Guidance for Heart Failure

There is coding guidance included in AHA Coding Clinic 1Q 2016 pp 10-11 that may impact the code assignment for the diagnosis of heart failure. The coding guidance involves how to code heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF). The new guidance effective with discharges of 3/18/2016 forward indicates that HFpEF is synonymous with systolic heart failure while HFrEF is synonymous with diastolic heart failure.

It is important to note that coding guidance refers to documentation provided by the provider. If the documentation was only in the echocardiogram, a query would still be required.

It is possible this could reduce physician queries for heart failure type if physicians document heart failure with preserved ejection fraction (systolic) or heart failure with reduced ejection fraction (diastolic). It is possible this could shift physician’s queries to the heart failure acuity form to capture just the acuity of the heart failure.

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