Cardiology Coding Alert

Don’t forget to report a secondary code from category N18- when reporting a code from category I12-.

You have probably encountered multiple cases of hypertension, also known as high blood pressure, in your cardiology practice. Hypertension can be a tricky diagnosis to report because you have so many ICD-10 codes to choose from. Also, the ICD-10-CM Official Guidelines for Coding and Reporting offer you extensive rules for reporting the many different types of hypertension.

Read the following tips to submit clean hypertension claims in your practice.

Tip 1: Turn to Category I11- for Hypertensive Heart Disease

If the cardiologist documents that the patient has hypertension along with heart conditions classified to categories I50.- (Heart failure), I51.4 (Myocarditis, unspecified)-I51.7 (Cardiomegaly), I51.89 (Other ill-defined heart diseases), or I51.9 (Heart disease

unspecified), you should report the appropriate code from category I11- (Hypertensive heart disease), according to the ICD-10 guidelines. If the patient has heart failure, you should also report an additional code from category I50.- to identify the exact heart failure type. However, if your cardiologist documents that the heart conditions I50.-, I51.4-I51.7, I51.89, and I51.9 are not related to the patient’s hypertension, you would code those conditions separately and sequence according to the circumstances of the admission or encounter, says Robin Peterson, CPC, CPMA, Manager of Professional Coding, Pinnacle Integrated Coding Solutions, LLC.

Coding example: The cardiologist diagnoses the patient, Mr. Smith, with hypertension, as well as myocardial degeneration (I51.5). The cardiologist also documents that Mr. Smith does not have heart failure. You should report I11.9 (Hypertensive heart disease without heart failure), as well as the secondary diagnosis of I51.5 (Myocardial degeneration) on your claim.

“Although the physician didn’t document the two conditions of hypertension and myocardial degeneration were related, ICD-10-CM assumes a causal relationship,” Peterson says.

Tip 2: Include Stage of CKD When Reporting Hypertensive CKD

If the cardiologist diagnoses the patient with both hypertension and a condition that falls under category N18- (Chronic kidney disease (CKD)), you should report the appropriate code from category I12- (Hypertensive chronic kidney disease), per the guidelines.

Caution: You can report the CKD as hypertensive even if the cardiologist does not specifically document the CKD as related to the patient’s hypertension because ICD-10 directs coders to assume the causal relationship in this case.

Additionally, when you report a code from category I12-, you should also report a secondary code from category N18- to indicate which stage of CKD the patient has. And, if the patient has acute renal failure along with the hypertensive CKD, you must also report the appropriate code for the acute renal failure.

Coding example: The patient has hypertensive CKD with stage 2 CKD. The cardiologist does not document the conditions are unrelated in the medical record. On your claim, you should report codes I12.9 (Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease) and N18.2 (Chronic kidney disease, stage 2 (mild)), in that order.

Tip 3: Decode This Hypertensive Heart and CKD Example

If the patient has hypertension with both heart and kidney involvement, you should report a code from category I13- (Hypertensive heart and chronic kidney disease), per the guidelines. If the patient also has heart failure, you should report the appropriate code from category I50- to identify the exact type of heart failure. Additionally, when you report a code from category I13-, you must also report the appropriate secondary code from category N18- to identify the CKD stage.

Caution: Since the codes in category I13- are combination codes, which include hypertension, heart disease, and CKD, if a patient has all three of these conditions, you must report a code from category I13-. You would not report the individual codes for hypertension, heart disease, and CKD, or codes from categories I11- or I12-.

Additionally, if the patient has both acute renal failure and CKD, you must report the appropriate code for acute renal failure.

Coding example: The cardiologist documents that the patient has hypertension with both heart and kidney involvement. The patient has stage 3 CKD. The patient also has acute systolic congestive heart failure. You should report the following codes on your claim:

I13.0 (Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease)

N18.3 (Chronic kidney disease, stage 3 (moderate))

I50.21 (Acute systolic (congestive) heart failure)

Don’t miss: Look out for documentation of end stage heart failure in the medical record. You should report I50.84 (End stage heart failure) for a patient with heart failure conditions classified in category I50.2-I50.43, according to ICD-10.

Tip 4: See Multiple Includes Diagnoses for I27.0

If the cardiologist diagnoses the patient with pulmonary hypertension, you should report the appropriate code from category I27- (Other pulmonary heart diseases).

Coding example: The cardiologist diagnoses the patient with heritable pulmonary arterial hypertension. You should report I27.0 (Primary pulmonary hypertension) for this condition.

Don’t miss: If you look under code I27.0 in the ICD-10 index, you will see that heritable pulmonary arterial hypertension, idiopathic pulmonary arterial hypertension, primary group 1 pulmonary hypertension, and primary pulmonary arterial hypertension are all included conditions under I27.0.

Tip 5: Observe Uncontrolled Hypertension Definition

Uncontrolled hypertension may refer to untreated hypertension or hypertension not responding to current therapeutic regimen. In either case, assign the appropriate code from categories I10-(Essential (primary) hypertension) through I15- (Secondary hypertension).

Coding example: The patient has hypertensive heart disease with cardiomegaly and acute on chronic diastolic congestive heart failure. These two conditions are related.

The cardiologist documents that the patient’s hypertension is uncontrolled because it is not responding to the current therapeutic regimen. You should report I11.0 (Hypertensive heart disease with heart failure) and I50.33 (Acute on chronic diastolic (congestive) heart failure) on your claim.