# Coding Basics- Hypertension; Use of Arrows



## smckinney (Aug 5, 2009)

I have two separate questions. Sometimes physicians state HBP or high blood pressure. When the physician uses this diagnosis, should it be coded as hypertension?

Also, physicians sometimes use up or down arrows in front of words when indicating a diagnosis. For example, a down arrow in front of thyroid or thyroidism and an up arrow in front of lipids or lipidemia. When the physician uses arrows as part of his/her diagnosis, is it appropriate to pick up the diagnosis?


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## rthames052006 (Aug 5, 2009)

smckinney said:


> I have two separate questions. Sometimes physicians state HBP or high blood pressure. When the physician uses this diagnosis, should it be coded as hypertension?
> 
> Also, physicians sometimes use up or down arrows in front of words when indicating a diagnosis. For example, a down arrow in front of thyroid or thyroidism and an up arrow in front of lipids or lipidemia. When the physician uses arrows as part of his/her diagnosis, is it appropriate to pick up the diagnosis?



In your second scenerio I would querry the physician.  In my opinion an up or down arrow could just mean elevated or decreased.  For the HBP I querry that also.  This is just how I was taught.  Any other takers...


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## heiditipherwell (Aug 5, 2009)

When I see HBP or LBP, I code as it states with 796.2 or 796.3.  I never code for a diagnosis of hypertension or hypotension unless clearly stated.   
I also agree with Roxanne's statement regarding the arrows.  This typically means that it was an elevated or decreased reading.  
Hope that helps. 
Heidi


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## smckinney (Aug 5, 2009)

Thanks everyone.

In considering the same issues for HBP and the use of up or down arrows...what happens if you see that the patient is on a medication for treatment of those conditions? Would you pick it up then or continue with query submission?


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## pamtienter (Aug 5, 2009)

I agree about querrying the provider. We educate our providers not to use arrows but to specify the specific condition, i.e. hyperthyroidism, hypertension, etc. hoping to alleviate having to wonder what they meant to say. If they use an arrow, they get the question. Our providers also mark ICD-9 codes on the charge ticket and by what they marked, you can see what they were meaning to say, but their documentation should match that actual diagnosis.
(In the ideal world...)


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## mitchellde (Aug 5, 2009)

bpct6501 said:


> I agree about querrying the provider. We educate our providers not to use arrows but to specify the specific condition, i.e. hyperthyroidism, hypertension, etc. hoping to alleviate having to wonder what they meant to say. If they use an arrow, they get the question. Our providers also mark ICD-9 codes on the charge ticket and by what they marked, you can see what they were meaning to say, but their documentation should match that actual diagnosis.
> (In the ideal world...)


I the real world also!


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## rthames052006 (Sep 1, 2009)

smckinney said:


> Thanks everyone.
> 
> In considering the same issues for HBP and the use of up or down arrows...what happens if you see that the patient is on a medication for treatment of those conditions? Would you pick it up then or continue with query submission?



I would still querry the physician because you will need to know if it's benign or malignant, or non specific 401.9


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