Debunk 3 Hypertension Myths That May Hurt Your Bottom Line
Published on Wed Nov 23, 2005
Learn why your cardiologist must specify primary or secondary
Satisfying yourself with an unspecified hypertension code, merely because your cardiologist did not accurately document the patient's condition, could lead your claim into limbo land.
Combat these three myths to ensure you find your way to the correct hypertension code every time. Myth 1: Just Writing 'Hypertension' Is OK If your cardiologist is in the habit of merely writing "hypertension" on the patient's record, then you should point this problem out to him or her.
"The real key to correct coding for hypertension lies with physician documentation, and we need to educate our [cardiologists] to tell us explicitly" what type of hypertension they're treating, says Charla Prillaman, CPC, CHCO, director of physician compliance for Carolinas Healthcare System in Charlotte, N.C. Cardiologists need to state the details of a patient's hypertension in the medical record, she adds.
Coding for hypertension "really comes down to documentation," agrees Jaime Darling, CPC, a coder with Graybill Medical Group in Escondido, Calif. Often cardiologists will simply write "hypertension" in the diagnosis portion of their notes, which leads a coder to nothing but 401.9 (Essential hypertension; unspecified), she says. Explain to your cardiologists that adequate information for medical purposes isn't always adequate for coding purposes.
Action: Ask your cardiologist to indicate whether a patient's hypertension is malignant or benign, and also to define how any other manifestations are related to the hypertension, Darling recommends. 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.
Myth 2: No Info? Assume It's Benign When you don't know whether the hypertension is malignant or benign, you shouldn't automatically assume your cardiologist means benign.
The hypertension table in the ICD-9-CM 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.
What to look for: "A patient has malignant hypertension when he or she 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 than benign hypertension.
Common assumption: Because benign hypertension is more [...]
