Cardiology Coding Alert

Surprise: You must indicate primary or secondary hypertensionTo avoid taking up your cardiologist's valuable time, you've got to be able to determine if documentation is sufficient to point you to a specific hypertension code.See if you make the grade with these hypertension true/false answers.Answer 1: FalseIf your cardiologist is in the habit of merely writing "hypertension" on the patient's record, you should point this problem out to him.Vital: The real key to correct coding for hypertension lies with physician documentation, and you must educate your cardiologists to tell you explicitly what type of hypertension they're treating, says Kristy F. Lane, CCP-P, coding practice specialist at the Heart and Vascular Group in Johnson City, Tenn. In other words, cardiologists need to state the details of a patient's hypertension in the medical record.Coding for hypertension really comes down to documentation. Often, cardiologists will simply write "hypertension" in the diagnosis portion of their notes, which leads you to nothing but 401.9 (Essential hypertension; unspecified), says Phyllis Frazier, SCP-CA, billing supervisor for Scranton Heart Institute PC in Clarks Summit, Penn. "Most insurance carriers won't accept an unspecified code any longer," Lane says.Action: Explain to your cardiologists that adequate information for medical purposes isn't always adequate for coding purposes. They need to indicate whether a patient's hypertension is malignant or benign and also define how any other manifestations are related to the hypertension. "You've got a multitude of specific hypertension codes to choose from," Lane says.For example, the cardiologist 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.Answer 2: FalseWhen you don't know whether the hypertension is malignant or benign, you shouldn't automatically assume your cardiologist means benign.Rule of thumb: "Never assume anything in coding," Lane says.Heads up: The hypertension table in the ICD-9 manual's index lists three possible categories into which hypertension may fall: Malignant, benign and unspecified. 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.Clues: "A patient has malignant hypertension when he has a recent significant increase over baseline blood pressure that is associated with target organ damage. There is usually vascular damage on funduscopic examination, such as flame-shaped hemorrhages or soft exudates," says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C. To diagnose malignant hypertension, papilledema must be present, Williams says. Up to 1 percent of patients with benign hypertension may develop malignant hypertension -- meaning malignant hypertension can be life-threatening and may cause a stroke but is much less common [...]