Ask Dr. Z

Can you provide some guidance on ICD-10 coding of cardiogenic shock with other cardiac issues? There is a Coding Clinic from the 3rd quarter 2020, page 26, that states: "Question: When a patient is admitted and is diagnosed with both cardiac arrest and cardiogenic shock, how is this coded? Answer: Assign only code I46.9, Cardiac arrest, cause unspecified. The cardiac arrest is coded rather than cardiogenic shock, since code R57.0, Cardiogenic shock, is located in Chapter 18, Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not elsewhere Classified, and the cardiac arrest is a more definitive diagnosis." Would this also apply in cases where the patient is admitted with acute heart failure and/or cardiomyopathy? Since cardiogenic shock is a sign and symptom code, would you ever code it in addition to cardiac conditions, or only when it is cardiogenic shock alone, with the underlying condition not yet determined?