Acute and Chronic Cor Pulmonale

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Pulmonary hypertension can be diagnosed when there is elevated blood pressure in the pulmonary circulation. It is classified into five different groups. Although cor pulmonale may be considered inherent to some types of pulmonary hypertension, its presence should be documented, as both can be reported when applicable.

Cor pulmonale can be diagnosed when the right side of the heart is affected by a pressure overload that induces changes in RV function and morphology. To diagnose cor pulmonale there should be evidence of pulmonary HTN-induced altered structure and/or function of the right ventricle, such as hypertrophy or dilation.

Cor pulmonale should not be diagnosed when RV dysfunction is due to left-sided heart disease or congenital heart disease. Cor pulmonale is usually a chronic condition but it can occur acutely secondary to a pulmonary embolism.

To support accurate code assignment for patients with pulmonary hypertension, providers should specify:

  • The pulmonary hypertension group classification (1-5) or the etiology of the pulmonary hypertension
  • Chronic cor pulmonale, if present
  • Right ventricular failure, if present (include acuity)
  • Example: Group 3 pulmonary hypertension secondary to COPD with chronic cor pulmonale and chronic right ventricular failure

For patients with an acute pulmonary embolism, documentation should specify acute cor pulmonale, if present. Coding guidelines currently only allow acute cor pulmonale code assignment for patients with a pulmonary embolus.

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