# Hypertension and Fibromuscular Dysplasia



## m.j.kummer (Jan 29, 2013)

This scenario involves a primary care physician.

A patient with family history of Fibromuscular Dysplasia (FMD) and hypertension that could not be controlled with medication had a renal ultrasound which showed renal artery stenosis due to FMD. The patient had renal artery angioplasty, the hypertension went away. At each follow up visit the provider continues to code 401.1. I believe the correct code would be 405.11 if it needs to be reported at all. 

Additionally the patient had an elevated cholesterol reading and was given Simvastatin. Cholesterol reading is in normal range after 3 months of diet, exercise and medication. Because of the FMD the vascular surgeon recommended Simvastatin continue in an effort to reduce the cholesterol to 70. I believe the ICD-9 code should be 447.3 FMD renal artery.

Once the vascular surgeon diagnosed FMD of the renal artery, protocol is to order MRA of the head and neck to check for disease in the carotid arteries. The MRA results were positive for FMD and bilateral internal carotid artery aneurysm (ICA) with recommendation of annual follow up MRA to check for change in the size of aneurysm. The physician used the ICD-9 codes 401.1 and 272.4 on the order for the follow up MRA. My thought is that the order should reflect the ICD-9 code for FMD and ICA. 447.8; 447.3 and 437.3.

What is your opinion and how would you present this to the ordering physician?


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## mjb5019 (Jan 29, 2013)

*comtrolled vs resolved*

It appears the angioplasty has resolved the hypertension-don't code it. The simvastatin appears to have controlled the elevated lipid- if the condition would return if the medication were stopped- code it as current. For the FMD the question becomes did the surgery resolve the FMD of the renal artery?


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## m.j.kummer (Jan 29, 2013)

mjb5019 said:


> It appears the angioplasty has resolved the hypertension-don't code it. The simvastatin appears to have controlled the elevated lipid- if the condition would return if the medication were stopped- code it as current. For the FMD the question becomes did the surgery resolve the FMD of the renal artery?



There is no cure for FMD. One can only treat the symptoms. Though the hypertension has resolved the underlying condition has not.


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