Anesthesia Coding Alert

Heads up: Pay attention to the new Excludes1 note.

Knowing that a patient has hypertension is an important fact for anesthesia providers to take into consideration as they map out and implement the anesthesia plan. When coding for cardiac cases, pay special attention to diagnoses such as primary pulmonary hypertension and how you’ll report it under ICD-10.

Starting point: The one-to-one crosswalk from ICD-9 to ICD-10 keeps primary pulmonary hypertension coding fairly simple. Previous ICD-9 code 416.0 (Primary pulmonary hypertension) has an identical descriptor in ICD-10 with I27.0 (Primary pulmonary hypertension).

ICD-9 coding rules: Code 416.0 applied to “Idiopathic pulmonary arteriosclerosis” and “Pulmonary hypertension (essential) (idiopathic) (primary),” according to a list with the code. It excluded pulmonary hypertension NOS and secondary pulmonary hypertension, which you reported with 416.8 (Other chronic pulmonary heart diseases).

ICD-10 changes: ICD-10 indexes “Arteriosclerosis, pulmonary (idiopathic)” to I27.0. Similarly, the index points to I27.0 for the entry “Hypertension, pulmonary, primary (idiopathic).”

The surprise comes with code I27.0’s Excludes1 note listing pulmonary hypertension NOS and secondary pulmonary hypertension. Note that you should report both secondary and NOS diagnoses using the secondary code I27.2 (Other secondary pulmonary hypertension).

Documentation: The cardiologist in charge of the case should document primary or idiopathic to help support the choice of I27.0. Your provider needs to verify the specific type of hypertension so your claim will be consistent with the surgeon’s.

Coder tips: “Other” code 416.8 crosses to both I27.89 (Other specified pulmonary heart diseases) and secondary hypertension code I27.2. If you report I27.2, you also should code the underlying condition.

Condition details: Pulmonary hypertension is high blood pressure affecting arteries in the lungs. The condition also affects the heart, which eventually weakens and fails as the right ventricle works harder to pump blood through the lungs.