Chronic Diastolic Heart Failure ICD-10 Code: I50.32

The ICD-10 code for chronic diastolic heart failure is I50.32 (Chronic diastolic (congestive) heart failure). This code is used when documentation specifies both the chronicity and the diastolic nature of the heart failure.

Understanding Diastolic Heart Failure

Diastolic heart failure (also called HFpEF - heart failure with preserved ejection fraction) occurs when the heart contracts normally but doesn't relax properly, causing filling problems. It's characterized by:

• Normal or near-normal ejection fraction (typically ≥50%)
• Impaired ventricular relaxation
• Elevated filling pressures

I50.3 Code Family for Diastolic Heart Failure

Selecting the Right Acuity Code

Acuity determination is critical:

Tip: If the patient is admitted for heart failure symptoms (dyspnea, edema worsening), it's typically acute (I50.31) or acute on chronic (I50.33), not chronic alone.

Common Coding Scenarios

Scenario 1: Stable Chronic Diastolic CHF

Documentation: "Chronic diastolic heart failure, NYHA Class II, stable on diuretics. Echo shows EF 55%."

Code: I50.32 (Chronic diastolic heart failure)

Rationale: Documented as chronic and stable. The preserved EF (55%) confirms diastolic type.

Scenario 2: Acute on Chronic Diastolic CHF Exacerbation

Documentation: "Acute on chronic diastolic heart failure exacerbation with volume overload. Known HFpEF, EF 60%."

Code: I50.33 (Acute on chronic diastolic heart failure)

Rationale: The exacerbation indicates acute decompensation of chronic diastolic HF. Use acute on chronic when patient has baseline chronic HF that has acutely worsened.

Scenario 3: CHF with Hypertension

Documentation: "Hypertensive heart disease with chronic diastolic heart failure."

Code: I11.0 (Hypertensive heart disease with heart failure)

Also code: I50.32 (Chronic diastolic heart failure)

Rationale: Hypertensive heart disease with heart failure requires both codes. I11.0 captures the hypertension-heart relationship; I50.32 specifies the type of heart failure.

Scenario 4: CHF Type Not Specified

Documentation: "Chronic congestive heart failure. Continue current medications."

Code: I50.9 (Heart failure, unspecified) - if truly unspecified

Rationale: If documentation doesn't specify systolic, diastolic, or combined, you cannot assume. Query the provider or use unspecified code.

Diastolic vs. Systolic vs. Combined

Don't confuse these categories:

Query if unclear: Documentation like "CHF" or "congestive heart failure" without type specification should prompt a query for systolic vs. diastolic.

"Code Also" Instructions

When coding I50.32, check for:

• Underlying cause: Hypertensive heart disease (I11.0), valvular disease, cardiomyopathy
• End stage heart failure (I50.84) - if applicable

Documentation Tips for Providers

To support accurate coding, documentation should include:

• Type: systolic, diastolic, or combined
• Acuity: acute, chronic, or acute on chronic
• EF percentage: helps confirm HF type
• Current status: stable, worsening, improved
• NYHA class: if known