Heart Failure with Reduced Ejection Fraction (HFREF) ICD-10-CM codes

Discover the ICD-10-CM codes used for heart failure with reduced ejection fraction (HFREF) diagnosis, including clinical info, billability, & more.

By Patricia Buenaventura on Aug 8, 2025.

Fact Checked by Karina Jimenea.

Use Code

What ICD-10 codes are used for HFREF?

The correct HFREF ICD codes are vital in precise diagnosis and treatment. Here are some commonly used codes:

I50.20: Unspecified systolic (congestive) heart failure

This code is generally used when the patient is known to have systolic heart failure, but the documentation does not specify whether it is acute, chronic, or acute on chronic.

I50.21: Acute systolic (congestive) heart failure

Used for patients diagnosed with acute heart failure.

I50.22: Chronic systolic (congestive) heart failure

Used when patients have a chronic form of systolic heart failure.

I50.23: Acute on chronic systolic (congestive) heart failure

This code applies when the patient suffers from systolic heart failure classified as acute on chronic.

Which HFREF ICD codes are billable?

Understanding which codes are billable is critical for appropriate medical billing:

I50.20: Yes, billable. This code is used when systolic heart failure is diagnosed, but no further specification is documented.
I50.21: Yes, billable. It applies to cases of acute systolic heart failure.
I50.22: Yes, billable. They are used when patients have a chronic form of systolic heart failure.
I50.23: Yes, billable. This code applies to systolic heart failure that is acute on chronic.

Clinical information

Heart failure with reduced ejection fraction (HFREF), or systolic heart failure, is a form of heart failure in which the left ventricle of the heart is not able to pump blood efficiently:

HFREF is characterized by a reduction in the percentage of blood leaving the heart each time it contracts, known as the ejection fraction.
Common causes include ischemic heart disease, hypertension, chronic kidney disease, chronic diastolic heart failure or heart failure with preserved ejection fraction (HFPEF), and valvular heart disease.
Symptoms may include breathlessness, fatigue, fluid retention, and decreased exercise tolerance.
Diagnosis typically involves a physical exam, patient history, and tests like echocardiograms, electrocardiograms, and blood tests.
Treatment generally includes lifestyle modifications, medications, and sometimes devices or surgical procedures.

Synonyms include

Systolic heart failure
Heart failure with low ejection fraction
Left ventricular failure
Reduced ejection fraction heart failure
Chronic systolic heart failure

Commonly asked questions

HFREF, or Heart failure with reduced ejection fraction, is a type of heart failure where the heart's left ventricle cannot pump blood effectively.

Symptoms may include breathlessness, fatigue, fluid retention, and decreased ability to exercise. However, some people may not experience symptoms in the condition's early stages.

Treatment generally includes lifestyle modifications, such as a healthy diet and regular exercise, medications to manage symptoms and slow disease progression, and in some cases, devices or surgical procedures.

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