How to Code CHF with Valvular Disease

Medical billing uses specific codes to categorize medical conditions for the proper reimbursement from insurance companies and Medicare. Valvular disease may occur with or without congestive heart failure (CHF). Careful attention to the correct codes will ensure the maximum reimbursement for the provider of medical services. You must also make sure that the procedure preformed is the same as the code definition and description corresponding to the code number assigned to the insurance billing form. Diagnosis codes are specific for each condition. Some conditions, such as CHF with valvular disease, will require more than one code.

Things You'll Need

• International Statistical Classification of Diseases and Related Health Problems, Tenth Edition (ICD-10)

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Instructions

• 1

  Locate the section of the ICD-10 coding manual that refers to cardiovascular disease. The coding manual is divided into sections for different diseases of the body, and the ICD-10 codes are diagnosis codes. You must receive a diagnosis from the medical provider in order to look up the corresponding billing code.

• 2

  Determine the correct subcode for the heart failure as diagnosed by the physician. Heart failure can be caused by different conditions, such as weakening of the heart muscle, and your billing code must be specific for the condition diagnosed.

• 3

  Code the bill for the exact condition diagnosed. Separate codes will apply to a compound diagnosis, such as CHF with valvular disease. You will need to know which heart valve is involved in the heart failure. Once this information is provided by the medical provider, a second billing code needs to be entered for the valvular disease.

• 4

  Enter the codes on the billing form required by the patient's insurance company.