Heart Failure

Patients with heart failure (HF)?*

About 5.7 million people in the United States have HF. It is a leading cause of hospital stays among people on Medicare2

Types of HFs I50.9:

Systolic I50.20

• Acute I50.21

• Chronic I50.22

• Acute on chronic I50.23

Diastolic I50.30

• Acute I50.31

• Chronic I50.42

• Acute on chronic I50.33

Combined systolic and diastolic I50.40

• Acute I50.41

• Chronic I50.42

• Acute on chronic I50.43

Other types of HFs

• End stage (D) I50.84

• Biventricular I50.82

• High output I50.83

• Right side I50.810

- Acute I50.811

- Chronic I50.812

- Acute on chronic I50.813

- Secondary to left HF I50.814

Due to HTN, code first: I11.01

Left HF I50.1

A normal heart’s ejection fraction (EF) is between 50% and 70%. However, patients with a normal EF may still have HF. It is called HF with preserved ejection fraction (HFpEF), I50.30. This happens when the heart muscle has become so thick and stiff that the ventricle holds a smaller than usual volume of blood, it might still seem to pump out a normal percentage of the blood that enters it. Though, the total amount of blood pumped is not enough to meet body’s needs. Contradictory, an EF higher than 75% may indicate a heart condition such as hypertrophic cardiomyopathy5, I42.2

Heart failure develops over time as the heart’s pumping action grows weaker. The most common signs and symptoms of heart failure are: shortness of breath (SOB), fatigue (tiredness), swelling in the ankles, feet, legs, abdomen, and veins in the neck2

Coronary artery disease (CAD) is the most common cause of HF. Other underlying conditions are hypertension (HTN), heart valves disorders, cardiomyopathy, diabetes, HIV, hyperthyroidism, and hypothyroidism3.

Acute HF is defined as a rapid onset of new or worsening signs and symptoms of HF. It is often a potentially life-threatening condition, requiring hospitalization, and emergency treatment is aimed predominantly at managing fluid overload and hemodynamic compromise4.

1 out of every 500 people has a hypertrophic

Types of cardiomyopathy I42.9

• Hypertrophic I42.2

• Hypertrophic obstructive I42.1

• Hypertensive I11.9 and I43

• Dilated I42.0

• Restrictive I42.5

• Diabetic E11.59 and I43

• Due to alcoholism I42.6 and F10.20

Monitor periodically these conditions and their plan of treatment. Some patients do not adhere to medications, diet or care plan. We recommend scheduling one face-to-face visit before July 1st, and one before December 31st.

References and Additional Notes:

* This tool is not intended to diagnose, evaluate or treat patients. Each provider is responsible for the clinical and diagnostic decisions pertinent to their patient’s medical care.

1. RAF weight is based on a community-nondual-aged member, please refer to: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2019.pdf

2. NIH. Heart Failure. Excerpted: https://www.nhlbi.nih.gov/health-topics/heart-failure

3. Mayo Clinic. Heart Failure. Excerpted: https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142

4. NIH. Acute Heart Failure: Definition, Classification and Epidemiology. Excerpted: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597697/

5. AHA. Ejection Fraction Heart Failure Measurement. Excerpted: http://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure/ejection-fraction-heart-failure-measurement