What is the appropriate ICD‑10 code for a patient with normal ejection fraction (55‑60%), concentric left‑ventricular hypertrophy, grade I diastolic dysfunction (impaired relaxation), and no pericardial effusion or tamponade?

ICD-10 Coding for Concentric LVH with Grade I Diastolic Dysfunction

The appropriate ICD-10 code is I11.9 (Hypertensive heart disease without heart failure) if hypertension is documented, or I51.9 (Heart disease, unspecified) if no hypertension is present.

Primary Coding Considerations

For patients with concentric left ventricular hypertrophy and preserved ejection fraction (55-60%), the coding depends entirely on whether hypertension is documented as the underlying etiology. 1, 2

If Hypertension is Present:

• Use I11.9 (Hypertensive heart disease without heart failure) as the primary code 1
• Concentric LVH with preserved EF represents target organ damage from hypertension but does not meet criteria for heart failure 1, 2
• The European Society of Cardiology defines concentric hypertrophy as increased LV mass with wall-to-radius ratio >0.42, which represents an adaptive response to chronic pressure overload 1

If No Hypertension is Documented:

• Use I51.9 (Heart disease, unspecified) as the primary code
• Consider I42.2 (Other hypertrophic cardiomyopathy) only if there is evidence of a primary cardiomyopathic process rather than secondary hypertrophy 2

Additional Coding for Diastolic Dysfunction

Grade I diastolic dysfunction (impaired relaxation) does NOT warrant a separate heart failure code when EF is preserved and the patient is asymptomatic. 1

• The American Society of Echocardiography defines Grade I diastolic dysfunction as E/A ratio ≤0.8 with peak E velocity ≤50 cm/sec, which typically indicates normal or low left atrial pressure 1
• Grade I diastolic dysfunction represents the earliest stage of diastolic abnormality and is commonly seen with LV hypertrophy without clinical heart failure 1
• Do not use I50.30-I50.33 (diastolic heart failure codes) unless the patient has symptomatic heart failure with elevated filling pressures 1, 3

Critical Coding Pitfalls to Avoid

The ICD-10 codes I50.2x (systolic heart failure) and I50.3x (diastolic heart failure) have suboptimal diagnostic performance in ambulatory settings and should only be used when clinical heart failure is present. 3

• A study examining 68,952 ambulatory encounters found that I50.3x codes for diastolic heart failure had sensitivity of only 34-39% and should not be used for asymptomatic diastolic dysfunction 3
• Preserved ejection fraction (55-60%) with Grade I diastolic dysfunction does not meet criteria for heart failure diagnosis 1, 4
• The ACC/AHA defines heart failure with preserved ejection fraction (HFpEF) as requiring both typical symptoms/signs of HF AND evidence of elevated filling pressures, not just echocardiographic abnormalities 1

Supporting Codes

If documented, add:

• I51.7 (Cardiomegaly) for the structural finding of LVH
• I10 (Essential hypertension) if hypertension is the underlying cause
• Any relevant codes for coronary disease, diabetes, or other comorbidities that may contribute to the LVH 1, 2

Clinical Context

Approximately 13% of patients with concentric LVH and normal EF progress to systolic dysfunction over 3 years, particularly with interval myocardial infarction or chronically elevated arterial impedance. 5

• Concentric LVH represents an adaptive hypertrophic response that maintains normal ejection fraction despite increased afterload 1, 6
• Grade I diastolic dysfunction reflects impaired relaxation but preserved systolic function and typically normal filling pressures 1
• This pattern is most commonly associated with chronic hypertension in elderly patients, particularly women 1, 4