Endocrinology Coding Alert
You Be the Coder: Don't Stop at 401.9 for Hypertension
Question: Would you explain how to select the most specific code for hypertension? Our endocrinologist often documents this diagnosis, and I don't think 401.9 is always the best code for us to use.
South Carolina Subscriber
Answer: You're right - 401.9 (Essential hypertension; unspecified) is often not the most specific code. But when physicians don't provide enough specific documentation about the diagnosis, coders are forced to report the more general code. Therefore, improved documentation is the first step toward reporting a more specific hypertension code.
Details: Ask your physicians to indicate whether a patient's hypertension is malignant or benign, and also to define how any other manifestations are related to the hypertension. For example, the physician should not just document hypertension and renal disease, but should indicate if the patient's hypertension is causing renal disease or if the renal disease is causing hypertension.
Next: Once you have this information, you are prepared to select the right code. First you must determine whether the patient's hypertension is malignant or benign. The fourth digit of the hypertension code you report will differ depending on which category you choose. For instance, you'll report 401.0 for malignant essential hypertension, 401.1 for benign essential hypertension, and 401.9 for unspecified.
Last step: Once you've determined malignant, benign or unspecified, you must identify whether the hypertension is primary or secondary. If the patient's hypertension is primary, meaning that another condition is not causing the hypertension, you need to list the hypertension code first, and report any manifestations as secondary diagnoses.
However, patients sometimes have hypertension with another condition, such as renal disease, and there are codes that include both conditions. For instance, the 403 code series indicates hypertensive renal disease, and the 404 series indicates hypertensive heart and renal disease.
Example: If your physician treats a patient with benign hypertensive heart disease with heart failure, you would report 402.11. This code indicates the patient's entire hypertensive status, but you would also need to report an additional code to specify the type of heart failure, such as 428.0 (Congestive heart failure, unspecified).
Secondary: A patient has secondary hypertension if the hypertension is "due to" or caused by another condition. For secondary hypertension, you should report the causal condition as the primary diagnosis and the hypertension as secondary. For example, if a patient has primary aldosteronism that is causing hypertension, you might report 255.10 (Primary aldosteronism) as the primary and 401.1 (Essential hypertension; benign) as the secondary.
- Published on 2004-10-19
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