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Healthcare Professionals / Progress Notes / Quality/Risk Management / Improving documentation of heart failure

Improving documentation of heart failure

By Jean E. Banzhof, RN, MSN, Clinical Documentation Improvement Manager

Heart Failure – Drop the C and add the D or S

Because Medicare does not recognize the term "CHF" as a co-morbid condition in its coding guidelines, heart failure must be diagnosed with severity and type of heart failure.  That's why physicians receive clarifications/queries for specificity of acuity and type of heart failure from Clinical Integration Specialists and Coding professionals. The following are the recognized levels of acuity and type:






Acute on Chronic



Combined Systolic and Diastolic

Chronic (Systolic or Diastolic) Heart Failure – it counts!

Secondary diagnoses are more important than ever before. Most chronic conditions do not increase severity. However, in the case of heart failure they do. Because it takes extra resources like Lasix, potassium, oxygen, daily weight and fluid monitoring to care for patients with chronic CHF, coding guidelines do include this chronic condition as a complicating condition for which there is reimbursement and credit for increased patient severity.

To get this credit, physicians must document the type of chronic heart failure (systolic or diastolic).  If systolic or diastolic heart failure is known as a chronic condition, diagnosing it will increase the severity and give you credit for managing the condition.

Replace: CHF-Stable, H/O CHF, Compensated CHF
With: Chronic Systolic Heart Failure, Chronic Diastolic Heart Failure

For more information, please contact Jean Banzhof at 544-4426; also please see related tip sheet. For more on the clinical problem of heart failure, please click here for NEJM article.


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