I50.40

HCC Category Mapping

What This Code Means

A heart condition affecting both the heart's pumping ability and its ability to relax and fill with blood, but the specific severity or duration is not specified.

Coding Tips

• •Use only when documentation does not specify acute, chronic, or acute on chronic status
• •Query provider for clarification on disease duration and current status to assign more specific code

Clinical Significance

Unspecified combined systolic and diastolic congestive heart failure indicates the patient has both impaired contraction and impaired relaxation of the heart. This dual dysfunction typically represents more advanced disease with greater symptom burden and worse prognosis than isolated systolic or diastolic failure. Acuity specification is essential for optimal coding.

Documentation Requirements

• ✓Provider documentation of combined systolic and diastolic heart failure
• ✓Evidence of both reduced ejection fraction AND diastolic dysfunction
• ✓Acuity should be specified — this code is used only when acute, chronic, or acute on chronic is not documented
• ✓Echocardiographic findings supporting both types of dysfunction
• ✓Current treatment plan addressing both components
• ✓Functional status and symptom assessment

Commonly Confused Codes