Cardiology Coding Alert

The ICD-10-CM Official Rules for Coding and Reporting list rules for twelve types of hypertension. Add that number to the many specific hypertension codes you will find in the ICD-10-CM manual, and that can add up to a tricky coding situation.

Answer the following five questions to keep your hypertension coding on the up and up.

Report Hypertensive Heart Disease Like This

Question 1: If the patient has hypertensive heart disease, how should I report it on my claim?

Answer: If your physician 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), report the appropriate code from category I11- (Hypertensive heart disease), according to the ICD-10-CM Guidelines. Your code choices include the following:

• I11.0 (Hypertensive heart disease with heart failure). Note: This code also includes hypertensive heart failure.
• I11.9 (Hypertensive heart disease without heart failure). Note: This code also includes hypertensive heart disease NOS.

Coding tip: If the patient has heart failure, also report an additional code from category I50.- to identify the exact heart failure type. Possible options include I50.21 (Acute systolic (congestive) heart failure), I50.31 (Acute diastolic (congestive) heart failure), I50.41 (Acute combined systolic (congestive) and diastolic (congestive) heart failure), and I50.811 (Acute right heart failure).

However, if your physician documents that the heart conditions I50.-, I51.4-I51.7, I51.89, and I51.9 are not related to the patient’s hypertension, instead report those conditions separately and sequence according to the circumstances of the encounter.

“A causal relationship is assumed between hypertension and heart involvement and hypertension and kidney involvement as the two conditions are linked by the term ‘with’ in the alphabetic index,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “These conditions should be coded as related even in the absence of provider documentation explicitly linking them unless the documentation clearly states the conditions are unrelated.”

Rely on Combination Category I13- For Hypertensive Heart and CKD

Question 2: The patient has hypertension with both heart and kidney involvement, and I am not sure how to report it. Can you help me?

Answer: If the patient has hypertension with both heart and kidney involvement, report a code from combination category I13- (Hypertensive heart and chronic kidney disease), per the guidelines. Those choices include the following:

• 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)
• I13.10 (Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease). Note: This code also includes hypertensive heart disease and hypertensive chronic kidney disease NOS.
• I13.11 (Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease)
• I13.12 (Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease)

Don’t miss: If your physician documents that the patient also has heart failure, such as with I13.0 and I13.12, report the appropriate code from category I50- to identify the exact type of heart failure.

Coding tip: Category II3- is a combination category for hypertensive heart and chronic kidney disease (CKD). When you report a code from category I13-, you must also report the appropriate secondary code from category N18- (Chronic kidney disease (CKD)) to identify the CKD stage, per the guidelines. If a patient has all three conditions (hypertension, heart disease, and CKD), then report the appropriate code from category I13-. Do not report individual codes for hypertension, heart disease, and CKD, or codes from categories I11- (Hypertensive heart disease) or I12- (Hypertensive chronic kidney disease).

Dial Into These 3 Codes For Hypertensive Crisis

Question 3: How should I code a hypertensive crisis?

Answer: Report one of the following codes from category I16- (Hypertensive crisis) for documented hypertensive urgency, hypertensive emergency, or unspecified hypertensive crisis:

• I16.0 (Hypertensive urgency)
• I16.1 (Hypertensive emergency)
• I16.9 (Hypertensive crisis, unspecified)

Coding tip: When reporting a code from category I16-, also report any identified hypertensive disease from I10 (Essential hypertension) through I15- (Secondary hypertension) and I1A (Other hypertension). Sequence these codes based on the reason for the encounter.

Pay Attention to Code First Notes

Question 4: My physician documented resistant hypertension. How should I report this?

Answer: Report I1A.0 (Resistant hypertension) for resistant hypertension. Code I1A.0 will also include apparent treatment resistant hypertension, treatment resistant hypertension, and true resistant hypertension.

Code first: You will see a Code first note with I1A- instructing you to code first the specific type of existing hypertension, if known, such as essential or secondary hypertension.

Don’t miss: Per the guidelines, resistant hypertension refers to the blood pressure of a patient with hypertension that remains above goal despite the use of antihypertensive medications. You should sequence a code for the specific type of existing hypertension first if known.

Remember I27 Covers Multiple Types of Pulmonary Hypertension

Question 5: The patient has idiopathic pulmonary arterial hypertension. How should I report this condition?

Answer: Report I27 (Primary pulmonary hypertension) for idiopathic pulmonary arterial hypertension. 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.