Coding Clinic Updates: Significant Changes to CHF and Diabetes Coding

Coding Clinic 1st Quarter 2016 Updates

The release of Coding Clinic 1st Quarter 2016 (effective with discharges which started on March 18, 2016) brought about two significant changes.

Heart Failure

The first change is the acceptance of the more contemporary heart failure classification terms that refer to ejection fraction and systolic function. These terms are outlined below:

Coding Clinic: new guidance on how to code heart failure

As a reminder, the provider must still document whether the heart failure is acute, chronic, or acute on chronic. It must also be documented if the patient has combined or systolic and diastolic dysfunction. Per previous Coding Clinic advice, the terms ‘exacerbation’ and ‘decompensated’ are coded as “acute”.


The second major change is the release of new guidance on how to code diabetes. Prior to this Coding Clinic, certain conditions were assumed to be related to diabetes and therefore did not require a linking statement between diabetes and a particular condition. The latest Coding Clinic significantly changes what can and cannot be assumed to be due to diabetes. The table below summarizes the new changes:

Coding Clinic: new guidance on how to code diabetes

This new guidance opens up the question of whether other conditions can also be assumed to be due to diabetes. For example, documentation of neuropathy is much more common than polyneuropathy, but can a coder assume that neuropathy is due to diabetes? To err on the safe side, a query should be placed to clarify if the patient has neuropathy or polyneuropathy. If the patient has neuropathy, then a query should be placed to establish a causal relationship between the two conditions. If the patient has polyneuropathy, then it is assumed to be due to diabetes.

And what about other common diabetic complications, for example, peripheral vascular disease? Can we assume that peripheral vascular disease is due to diabetes? Until additional guidance is released by Coding Clinic, coders should continue to follow best practices and query providers to document if there is a cause-and-effect relationship between a condition and diabetes.

Per pervious Coding Clinic advice, documentation such as “neuropathy due to diabetes”, “diabetic neuropathy”, or “diabetes with neuropathy” are all acceptable forms of documentation to establish an association or causal relationship between diabetes and a related complication. It will be interesting to see if Coding Clinic offers further guidance in future publications.

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