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CHF -- Comprehensive List of Preferred Codes ICD Codes: Source: HealthLeaders.com (in CAPs) and also, from Merck: Level 1 Dx Codes (file: H:/vol1/Medical/CHF/Codes/CHF_alg and for Rx: CHF_ndc2) 398.91-Rheumatic Heart Failure (congestive) 402.01-Malignant Hypertensive Heart Disease with CHF 402.11-Benign Hypertensive Heart Disease with CHF 402.91-Hypertensive Heart Disease with CHF 404.00-MAL HYPERTEN HEART/REN W/O CHF/RF 404.01-Hypertensive Heart and Renal Disease, Malignant, With CHF 404.03-Hypertensive Heart and Renal Disease, Malignant, With CHF 404.10-BEN HYPERTEN HT/REN W/O CHF/RF 404.11-Hypertensive Heart And Renal Disease, Benign, With CHF 404.13-Hypertensive Heart And Renal Disease, Benign, With CHF 404.90-HYPERTEN HT/REN NOS W/O CHF/RF 404.91-Hypertensive Heart And Renal Disease, Unspecified, With CHF 404.93-Hypertensive Heart + Renal Disease, Unspecified, With CHF 425.* -Cardiomyopathy 425.2-Obscure Cardiomyopathy of Africa 425.4-Other Primary Cardiomyopathies 425.5-Alcoholic Cardiomyopathy 425.7-Nutritional and Metabolic Cardiomyopathy 425.8-Cardiomyopathy In Other Diseases Classified Elsewhere 425.9-Secondary Cardiomyopathy, Unspecified 428.* -Heart Failure 428.0-Congestive Heart Failure 428.1-Left Heart Failure 428.9-Heart Failure, Unspecified 514 - Pulmonary edema;Secondary Dx
CPT's 78460, 78461, 78464, 78465, 78472, 78473, 78475, 78478, 78480, 78891, 78990, E&M's (office, hosp., referral) + 92950-93799; 93000, 93015, 93307, 93320, 93325, 93350, 93503, 93510, 93526, 93541, 93798 DF: The prevalence of clinically documented CHF was 27.1% (1376/5083). The ICD code 428 (CHF), assigned as the primary or a secondary discharge diagnosis, was associated with 62.8% sensitivity, 95.4% specificity, 83.5% positive predictive value, 87.4% negative predictive value, and a 24.8% underenumeration of CHF-related hospitalizations. An algorithm based on a series of ICD codes was associated with 67.1% sensitivity, 92.6% specificity, 77.1% positive predictive value, 88.3% negative predictive value, and a 13.0% underenumeration of CHF-related hospitalizations.
Conclusions: Reliance on ICD codes results in the exclusion of 1/3 of the patients with clinical evidence of acute CHF. This underenumeration is compounded by the typical reliance on the first listed diagnosis. CHF may be a greater public health problem than currently recognized. The allocation of resources for relevant surveillance, research, medical care, and preventive efforts should be reevaluated. Arch Intern Med. 2000;160:197-202 Ho KK, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol. 1993;22:6A-13A. Krumholz HM, Parent EM, Tu N, et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med. 1997;157:99-104. Graves EJ, Gillum BS. National Hospital Discharge Survey: Annual Summary, 1994. Vital Health Stat. 1997;128:1-50. Graves EJ, Gillum BS. Detailed Diagnoses and Procedures, National Hospital Discharge Survey, 1994. Vital Health Stat. 1997;127:1-145. Rich MW. Epidemiology, pathophysiology, and etiology of congestive heart failure in older adults. J Am Geriatr Soc. 1997;45:968-974. |