Anesthesia Coding Alert

ICD-10 eliminates malignant/benign dilemma for hypertensive heart disease.

When coding for procedures involving patients with hypertensive heart disease, you currently need to know whether the disease is malignant or benign and whether the patient experienced heart failure. That will change after ICD-10 implementation, so familiarize yourself with the coding differences now.

The diagnosis: In hypertensive heart disease, hypertension leads to heart disease. As the current ICD-9 codes indicate, heart failure may or may not be present:

• 402.0x, Hypertensive heart disease; malignant
• 402.1x, Hypertensive heart disease; benign
• 402.9x, Hypertensive heart disease; unspecified

You also have two fifth-digit options:

• 0, ... without heart failure
• 1, ... with heart failure

ICD-9 coding rules: The terms "benign" and "malignant" in the ICD-9 hypertensive heart disease codes can cause problems. If physicians don't include those terms in their hypertension documentation, coders are left with an "unspecified" code as the only compliant option.

A second coding requirement for ICD-9 is that you should report the heart failure type (428.x, Heart failure), if applicable and if known.

ICD-10 changes: ICD-10 will simplify your coding by eliminating the terms "benign" and "malignant" from your choices. The new ICD-10 codes will be:

• I11.0, Hypertensive heart disease with heart failure
• I11.9, Hypertensive heart disease without heart failure.

Under ICD-10, your coding will still vary based on heart failure (I11.0) or no mention of heart failure (I11.9). As with ICD-9, you should use an additional code to report the heart failure type, when present.

Documentation will no longer need to distinguish between benign and malignant hypertension. But if you're reporting I11.0, you will need to see the heart failure type so you may code it, as well (I50.-).

Under both ICD-9 and ICD-10, hypertensive heart disease codes apply only when documentation states or implies a causal relationship between the two. For example, the documentation may state the heart disease is "due to hypertension" or imply the relationship by calling the heart disease "hypertensive." If there's no documented relationship, you should report the heart disease and hypertension separately.

Coder tips: Coding notes state that I11.9 is appropriate for hypertensive heart disease NOS (not otherwise specified). You can report I11.9 if there's no mention of heart failure in the documentation.

You'll also avoid confusion if you alert everyone involved with coding to expect ICD-10 codes to begin with a letter followed by digits. In this case, the code begins with the letter "I" followed by the number "11." The similarities between letter "I" and number "1" could cause a mix-up.