# "mild pulmonary hypertension"



## Lisa Bledsoe (Aug 30, 2010)

I have an echo report that has this statement as part of the "overall impression".  BUT - the "findings" state "the pulmonic valve was structurally normal with no regurgitation".  So, is pulmonary hypertension reportable or not?  The "reason" for the echo was dizziness...


----------



## Lisa Bledsoe (Aug 31, 2010)

Anyone??


----------



## alawton083 (Aug 31, 2010)

I always go with the impression before the findings...sounds like maybe the pt has hypertension without regurgitation...?


----------



## Lisa Bledsoe (Aug 31, 2010)

I'm still not sure.  If the valve is structurally normal can you still have pulmonary hypertension?


----------



## alawton083 (Aug 31, 2010)

I looked on mayoclinic for some help...

"Pulmonary hypertension begins when tiny arteries in your lungs, called pulmonary arteries, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through your lungs, which raises pressure within the arteries in your lungs. As the pressure builds, your heart's lower right chamber (right ventricle) must work harder to pump blood through your lungs, eventually causing your heart muscle to weaken and eventually fail completely."

http://www.mayoclinic.com/health/pulmonary-hypertension/DS00430

"Pulmonary valve regurgitation occurs when the valve does not close completely, causing blood to leak backward into the right ventricle. The excess blood makes the right ventricle work harder than normal. Over time, this extra pressure on the right ventricle reduces its ability to pump blood (a condition called right-sided heart failure)."

http://www.mayoclinic.org/pulmonary-valve-disease/pulmonary-regurgitation.html

Sounds to me like both conditions can lead to blood pooling in the heart, just with different causes. (narrowed pulmonary arteries or incomplete valve closing)


----------



## sbicknell (Aug 31, 2010)

Of course I again dont have my DX book in front of me but...........valve regurg and HTN are 2 different things. You can have one without the other

Pulmonary HTN doesn't really have anything to do with the valve.  The HTN is basically the blood is pumping so hard it puts pressure on the pulmonary vessel walls.  Pulmonary HTN is 416.0  

Pulmonary valve regurg is 424.3 and is when the blood crosses thru the Pulm valve but there is an amount that back-flows (regurgitation) thru the valve because the valve does not close tight. Can be a little bit of back-flow or can be severe (leading to valve repair or replacement)

If his overall impression is mild pulmonary HTN, then code 416.0


----------



## ohn0disaster (Sep 1, 2010)

Just wanted to throw this out there real quick.

The code for Pulmonary Hypertension is 416.8, unless it's stated as Primary. 416.0 is the code used for Primary Pulmonary Hypertension.


----------



## Lisa Bledsoe (Sep 1, 2010)

Thank you to everyone for your input.  I still am not comfortable with giving this pt the dx of pulmonary htn based on the statement "mild pulmonary hypertension".  The claim had previously been submitted (and denied) with 780.4 (they symptom for which the echo was ordered).  This is not on the approved ICD-9 list per Trailblazer.  I will query the physician about his statement.  THANKS TO ALL!!


----------



## preserene (Sep 5, 2010)

I'm still not sure. If the valve is structurally normal can you still have pulmonary hypertension? 
__________________
Lisa Curtis, CPC, CPMA, CEMC, COBGC  

Yes, Lisa, it can still by many means; it is called Secondary pulmonary Hypertension and actually these types are more commoner than Primary. 
Read this passage please you would understand better. If not clear please  be back with which area is your doubt. I am in a hurry to prepare for my exam (within 2-3wks time). Otherwise  I would explain in a better way.
Thank you 

What is Pulmonary Hypertnsion?
The right ventricle pumps blood returning from the body into the pulmonary arteries to the lungs to receive oxygen. The pressures in the lung arteries (pulmonary arteries) are normally significantly lower than the pressures in the systemic circulation. When pressure in the pulmonary circulation becomes abnormally elevated, it is referred to as pulmonary hypertension, pulmonary artery hypertension, or PAH.
Pulmonary hypertension generally results from constriction, or stiffening, of the pulmonary arteries that supply blood to the lungs. Consequently, it becomes more difficult for the heart to pump blood forward through the lungs. This stress on the heart leads to enlargement of the right heart and eventually fluid can build up in the liver and other tissues, such as the in the legs.

 Symptoms of pulmonary hypertension is shortness of breath, cough, fatigue, dizziness lethargy , sometime C/o chest pain angina and in advanced stage heart Failure.
Hypoxia is one of the main signs



*Classifications:*It is generally classified as 1) primary pulmonary hypertension (not caused by any other disease or condition); and
 2) secondary pulmonary hypertension (caused by another underlying condition). Secondary pulmonary hypertension is much more common than primary pulmonary hypertension.
A *newer classification *of this condition is based on the main underlying cause of pulmonary hypertension. This system classifies the condition based on whether it is due to:
left sided heart disease, 
lung disease, 
blood clots, 
constriction of arteries due to any reasons (including primary pulmonary hypertension), and 
obstruction from outside of blood vessel (for example from diseases of the chest wall compressing the blood vessels).
So as such, it can be due  to too much pressure, too much blood pumped into,  or blockage any where that ultimately brings blood to the pulmonary  circulation can be a  cause for Pulmonary Hypertension.
So the valve can be normal without regurgitation, yet it can occur, say, for eg, Pulmonary Embolism  can cause too.
Pulmonary hypertension can be caused by diseases of the heart and the lungs, such as:
chronic obstructive pulmonary disease (COPD)
emphysema,
failure of the left heart ventricle, 
•	recurrent pulmonary embolism (blood clots traveling from the legs or pelvic veins obstructing the pulmonary arteries or chronic thromboembolic pulmonary hypertension), or 
underlying diseases such as scleroderma. 
*Other conditions that may cause pulmonary hypertension include*:
dermatomyositis, 
systemic lupus erythematosus, 
sarcoidosis, 
human immunodeficiency virus (HIV), and 
advanced liver disease (porto-pulmonary hypertension).
Pulmonary hypertension can also be caused by chronic low blood oxygen levels as in some patients with sleep apnea or other long-standing (chronic) lung disease. 
Again, pulmonary hypertension caused by these other illnesses can also be referred to as secondary pulmonary hypertension.
Primary pulmonary hypertension is an unusually aggressive and often fatal form of pulmonary hypertension that commonly affects young people
A genetic cause of the familial form of primary pulmonary hypertension has been discovered
*no clear statistical data *on the prevalence of this condition - This *may be due to the fact that many other diseases may cause or contribute to pulmonary hypertension. Often, these other conditions may be more readily diagnosed and treated without detecting pulmonary hypertension. Therefore, the data on prevalence of pulmonary hypertension may be obscured. *
Many tests, such as echocardiogram, may be performed that be give us clues to the possibility of pulmonary hypertension. But the gold standard (the best test available) is right heart catheterization.

Pulmonary hypertension is defined as the mean pulmonary artery blood pressure greater than 25 millimeter of mercury (mmHg) measured* by right heart catheterization*.


----------

