Complacent Coding for Hypertension Can Shortchange Your Practice
Published on Thu Apr 01, 1999
Just because hypertension (401-405) is a common diagnosis for cardiology practices doesnt mean its always coded correctly, experts warn. Complicating the matter is the confusion surrounding the definitions of malignant and benign. Finally, some hypertensive conditions shouldnt be coded in this series at all. Accordingly, the key to reducing denials and increasing reimbursement is to understand the various types of hypertension and to code each one correctly.
Tip: Most coders refer to the hypertension table in the alphabetic index in the ICD-9-CM manual. Although thats a good place to start, remember to verify hypertension codes in the tabular index for fourth and fifth digit specificityor your claim could be denied.
1. Essential hypertension (401). Whatever you do, do not bill for this truncated code because it will automatically result in a denial. (Medicare notes its one of the top five diagnostic codes most denied for lack of specificity.)
In fact, out of all codes in this series (401-405), about 80 percent are either nonspecific or require an additional digit. For example, all codes require at least a fourth digit to specify whether the condition is malignant or benign, while those in 403 (hypertensive renal disease) and 404 (hypertensive heart and renal disease) also require a fifth digit subclassification to indicate whether the hypertension is associated with organ failure.
2. Essential hypertension (401.0 to 401.9). Selecting the right code in this category depends on a clear understanding of the definition of essential hypertension, as well as distinguishing among malignant, benign and unspecified classifications of the disease process.
In about 90 percent of cases, the specific cause for the hypertension cannot be determined, so the term essential is used, explains Brendan Phibbs, MD, chief of cardiology at Kino Community Hospital in Tucson, AZ, and author of The Human Heart: A Basic Guide to Heart Disease. Essential hypertension is associated with certain risk factors, such as family history, race, stress, obesity, poor diet, and lack of exercise, he says.
However, just because the cause of the hypertension cannot be determined does not mean an appropriate diagnostic code cannot be allocated, stresses Nancy Reading, RN, BS, CPC, principal of Reading Reimbursement Consultants, a multi-specialty coding and reimbursement consulting firm in Salt Lake City, UT.
One of the biggest problems I see with diagnostic coding in cardiology practices is that 401.9 (unspecified hypertension) has been listed on the superbill as a convenience and, over time, has inadvertently become a dump code for all hypertension, she says.
Such dump coding can directly affect reimbursement. For instance, if you code 401.9 (unspecified) [...]
