Joan, hi. This can be a loaded question. The major issue is how does the patient present. If it's a fluid overload patient with respiratory symptoms, then there undoubtedly is pulmonary edema (check the x-ray). If it's a heart failure patient and the BNP is significantly elevated, then the patient has acute diastolic failure (on top of whatever baseline heart failure status the patient had before). If a non-heart failure patient comes in with fluid overload and respiratory symptoms and signs of pulmonary edema, this may be noncardiac pulmonary edema, and there's a specific code for that. The nephrologist should be able to help with that distinction. In either case, the patient will probably be dialyzed to get off the excess fluid. And, in either case, the patient may appear in acute respiratory failure, either due to the acute heart failure or the acute noncardiac pulmonary edema. On the other hand, if the only symptoms are limited to peripheral edema, then you either have right heart failure, if the patient is a right heart failure patient to begin with, or just plain "volume overload."
Can you give us one or two scenarios of recent patients we can go over in light of the above?