I50.84
BillableEnd stage heart failure
HCC Category Mapping
V28HCC 222 — End-Stage Heart Failure
0.473V24HCC 85 — Congestive Heart Failure
0.368ESRDHCC 85 — Congestive Heart Failure
0.000RxHCCHCC 186 — Heart Failure
0.000What This Code Means
The heart has reached its final stage of failure where it can no longer sustain adequate circulation despite maximum medical therapy, often requiring advanced interventions like transplant or mechanical support.
Coding Tips
- •Confirm documentation explicitly states 'end stage' or 'terminal' heart failure or NYHA Class IV with refractory symptoms
- •This code indicates the most severe form of heart failure and should be used cautiously
Clinical Significance
End stage heart failure represents the most severe and terminal form of heart failure where all available medical therapies have been exhausted. These patients are typically being considered for or have been deemed ineligible for heart transplantation or mechanical circulatory support. This is the highest-acuity heart failure code and carries the most significant V28 RAF weight among all heart failure codes.
Documentation Requirements
- ✓Provider must explicitly document 'end stage' heart failure or equivalent terminology (Stage D heart failure, refractory heart failure)
- ✓Documentation that standard medical therapies have been maximized and are no longer effective
- ✓Advanced therapy evaluation status: transplant candidacy, ventricular assist device consideration
- ✓Functional status — typically New York Heart Association Class IV
- ✓Palliative care or hospice discussions if applicable
- ✓Detailed medication regimen including any intravenous inotropic support
Commonly Confused Codes
I50.22 — Chronic systolic heart failure: chronic but not end stage — patient still responds to medical therapyI50.23 — Acute on chronic systolic heart failure: acute exacerbation, but patient may improve — not necessarily end stageI50.82 — Biventricular heart failure: advanced but not specifically end stageI50.9 — Heart failure, unspecified: completely nonspecific — never use when end stage is documentedZ87.39 — Personal history of other diseases of the circulatory system: use only if heart failure has resolved (e.g., post-transplant)
Code Hierarchy
└I50Heart failure└I50.8Other heart failure└I50.84End stage heart failure
└I50.84End stage heart failure