Cardiology Coding Alert

Report I95.0 for idiopathic hypotension.

You will find at least six codes for hypotension in the ICD-10-CM code set, including the well-known orthostatic hypotension. That means you need to brush up on these different types of hypotension, as well as any pertinent ICD-10-CM coding notes.

Read on to learn more to keep your coding on the up and up.

Hypotension Equals Low Blood Pressure

FAQ 1: How would you define hypotension?

Answer 1: Hypotension is abnormally low blood pressure. Optimal blood pressure is considered a reading that is less than 120/80 (systolic/diastolic).

When a patient has hypotension, his blood pressure will measure lower than 90/60 (systolic/diastolic), according to Catherine Brink, BS, CPC, CMM, president of Healthcare Resource Management in Spring Lake, New Jersey.

Choose Appropriate Hypotension ICD-10-CM Code

FAQ 2: What are the ICD-10-CM codes you can report for the different types of hypotension?

Answer: You have many hypotension ICD-10-CM choices, including the following:

• I95.0 (Idiopathic hypotension). A patient is usually given the diagnosis of idiopathic hypotension when the underlying condition causing the hypotension is unknown. Idiopathic hypotension can be categorized as primary or secondary neurogenic or non-neurogenic.
• I95.1 (Orthostatic hypotension). This code includes postural hypotension.
• I95.2 (Hypotension due to drugs). This code also includes orthostatic hypotension due to drugs. Per ICD-10-CM, you should report an additional code for the adverse effect, if applicable, to include the drug from codes T36- (Poisoning by, adverse effect of and underdosing of systemic antibiotics) through T50- (Poisoning by, adverse effect of and underdosing of mineralocorticoids and their antagonists).
• » I95.3 (Hypotension of hemodialysis). This code also includes intra-dialytic hypotension.
• » I95.81 (Postprocedural hypotension). Patients may experience postprocedural hypotension after they come out of anesthesia on the day of surgery or in the first days after surgery. Causes of postprocedural hypotension include infections, fever, respiratory distress, reactions from anesthesia, or hypovolemia.
• » I95.89 (Other hypotension). This code also includes chronic hypotension.

Focus on Orthostatic Hypotension Dx

FAQ 3: What is orthostatic hypotension?

Answer: Orthostatic hypotension is a very common type of hypotension that occurs when the patient’s blood pressure drops when they go from sitting to standing. This reading is in comparison to the patient’s blood pressure while sitting. You should report this condition with I95.1.

Caution: Check the medical record carefully to make sure your cardiologist specifically documented “orthostatic hypotension,” along with the patient’s vitals. When the physician simply documents “hypotension,” your code selection would be I95.9, not I95.1.

When coding orthostatic hypotension, the patient’s blood pressure lying down, sitting, and standing should be documented.

Tip: According to an Excludes1 note in the ICD-10-CM code set, I95.1 does not include neurogenic orthostatic hypotension [Shy-Drager] (G90.3) or orthostatic hypotension due to drugs (I95.2).

Keep Eye Out for Common Symptoms

FAQ 4: What are common symptoms to look out for when it comes to hypotension?

Answer: Common symptoms of hypotension include dizziness or lightheadedness, fainting, fatigue, nausea, or trouble concentrating. In severe cases, it can be life-threatening, says Rebecca Sanzone, CPC, CPMA, compliance administrator at St. Vincent Medical Group/Ascension Health in Indianapolis, Indiana. But low blood pressure without these serious symptoms is usually not unhealthy.

However, many people have no symptoms, Sanzone adds.

“A coder should never code hypotension based solely on current vitals or daily blood pressure readings. If the provider has not specified hypotension in the documentation you may want to query the physician,” says Robin Peterson CPC, CPMA, senior consultant; compliance review, education, and training, Pinnacle Enterprise Risk Consulting Services in Centennial, Colorado.