I50.43

I50.43: Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure

Billable / specific codeICD-10-CM

I50.43 is a billable, specific ICD-10-CM code for acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure. It is valid for submission on a claim.

Check I50.43 with the rest of the claim: free scrubber

Excludes2 inherited from the categories above I50.43

Not part of this code, but both may be coded when both are present.

Written on I50: Heart failure

cardiac arrest (I46.-)
neonatal cardiac failure (P29.0)

Risk adjustment

I50.43 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 224 Acute on Chronic Heart Failure0.360 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

I50.43 is named in 48 Medicare coverage policies: 48 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52458Automatic External Defibrillators - Policy Article
A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
A53026Billing and Coding: Bariatric Surgery Coverage
A53986Billing and Coding: Percutaneous Ventricular Assist Device

Alphabetic index entries that lead here

Failure, failed›heart›with›decompensation›combined systolic and diastolic
Failure, failed›heart›diastolic›combined with systolic›acute›and(on) chronic (congestive)
Failure, failed›heart›diastolic›combined with systolic›chronic›and(on) acute (congestive)
Failure, failed›Note: heart failure stages A, B, C, and D are based on the American College of Cardiology and American Heart Association stages of heart failure, which complement and should not be confused with the New York Heart Association Classification of Heart Failure, into Class I, Class II, Class III, and Class IV›systolic›combined with diastolic›acute›and(on) chronic (congestive)
Failure, failed›Note: heart failure stages A, B, C, and D are based on the American College of Cardiology and American Heart Association stages of heart failure, which complement and should not be confused with the New York Heart Association Classification of Heart Failure, into Class I, Class II, Class III, and Class IV›systolic›combined with diastolic›chronic›and(on) acute (congestive)
Failure, failed›heart›with›decompensation›with›reduced ejection fraction›with diastolic dysfunction

Code history

Unchanged in every release from FY2024 to FY2027.