What is the preferred term for right heart failure in ICD (International Classification of Diseases) terms?

Preferred Term for Right Heart Failure in ICD Terms

The preferred ICD term for right heart failure is "Right ventricular failure" (I50.810). This term is recognized in the International Classification of Diseases (ICD) coding system as the most appropriate designation for right-sided heart failure.

Understanding Right Heart Failure

Right heart failure (RHF) is defined as a clinical syndrome in which symptoms and signs are caused by dysfunction and/or overload of the right heart structures, predominantly the right ventricle (RV), resulting in:

• Systemic venous hypertension
• Peripheral edema
• Impaired ability of the right heart to provide adequate tissue perfusion 1

The American Heart Association defines RHF as a complex syndrome in which patients present with signs and symptoms of heart failure resulting from right ventricular dysfunction 2.

ICD Coding for Right Heart Failure

When coding for right heart failure in medical documentation, the following hierarchy applies:

1. Primary code: Right ventricular failure (I50.810)

   • This is the preferred term for isolated right heart failure

2. Secondary codes may include:

   • Right heart failure secondary to left heart failure (I50.814)
   • Biventricular heart failure (I50.82) when both ventricles are affected
   • Acute right heart failure (I50.811)
   • Chronic right heart failure (I50.812)
   • Acute on chronic right heart failure (I50.813)

Clinical Manifestations Relevant to Coding

When documenting to support the ICD code for right heart failure, include:

• Elevated right atrial pressure and jugular venous distention
• Peripheral edema
• Congestive hepatomegaly
• Evidence of right ventricular dysfunction on imaging 3
• Ascites in advanced cases

Diagnostic Criteria Supporting the Code

The diagnosis of right heart failure requires the presence of:

1. Signs of elevated right atrial and venous pressures (including dilation of neck veins)
2. At least one of the following:
   • Compromised right ventricular function
   • Pulmonary hypertension
   • Peripheral edema and congestive hepatomegaly 1

Distinguishing Right from Left Heart Failure in Coding

The European Society of Cardiology guidelines clarify that "right and left heart failure refer to syndromes presenting predominantly with congestion of the systemic or pulmonary veins" 2. This distinction is important for accurate ICD coding:

• Right heart failure presents with systemic venous congestion (ankle swelling, hepatomegaly)
• Left heart failure presents with pulmonary congestion (pulmonary edema)

Etiology Considerations for Coding

When coding right heart failure, consider documenting the underlying cause:

• Right ventricular infarction
• Pulmonary hypertension
• Left heart failure (most common cause)
• Pulmonary embolism
• Congenital heart disease
• Valvular heart disease

Key Takeaways for Coding

1. Use "Right ventricular failure" (I50.810) as the primary ICD term
2. Document acuity (acute, chronic, or acute on chronic)
3. Specify if secondary to left heart failure when applicable
4. Include supporting clinical findings in documentation
5. Document any underlying causes to support additional codes

Remember that accurate coding is essential for proper documentation, reimbursement, and tracking of disease prevalence and outcomes.