I50.33
BillableAcute on chronic diastolic (congestive) heart failure
HCC Category Mapping
V28HCC 224 — Acute on Chronic Heart Failure
0.268V24HCC 85 — Congestive Heart Failure
0.368ESRDHCC 85 — Congestive Heart Failure
0.000RxHCCHCC 186 — Heart Failure
0.000What This Code Means
A sudden worsening of a long-standing diastolic heart condition where the stiffened heart muscle cannot relax or fill properly, causing acute symptoms.
Coding Tips
- •Requires documentation of both chronic diastolic heart failure AND acute decompensation
- •Look for evidence of chronic disease with recent acute worsening or exacerbation
Clinical Significance
Acute on chronic diastolic congestive heart failure represents acute decompensation superimposed on known chronic diastolic dysfunction. This is one of the most clinically significant heart failure codes, reflecting patients with the highest resource utilization including hospitalizations and intensive outpatient management. It carries the highest V28 RAF weight among diastolic heart failure codes.
Documentation Requirements
- ✓Documentation must clearly indicate BOTH chronic diastolic heart failure AND acute exacerbation or decompensation
- ✓Evidence of chronic disease: history of diastolic heart failure, prior echocardiograms showing diastolic dysfunction
- ✓Evidence of acute worsening: new or worsening symptoms, increased edema, respiratory distress
- ✓Preserved ejection fraction with elevated filling pressures or brain natriuretic peptide levels
- ✓Precipitating factor for acute decompensation if identified
- ✓Treatment plan addressing both acute episode and chronic management
Commonly Confused Codes
I50.31 — Acute diastolic heart failure: use only for new onset acute disease without chronic heart failure historyI50.32 — Chronic diastolic heart failure: use when chronic disease is stable without acute worseningI50.23 — Acute on chronic systolic heart failure: use when systolic dysfunction (reduced ejection fraction) is specifiedI50.43 — Acute on chronic combined systolic and diastolic heart failure: use when both types are documentedI50.813 — Acute on chronic right heart failure: right-sided heart failure specifically
Code Hierarchy
└I50Heart failure└I50.3Diastolic (congestive) heart failure└I50.33Acute on chronic diastolic (congestive) heart failure
└I50.33Acute on chronic diastolic (congestive) heart failure