EM Coding Alert

The organ-related categories with ICD-10 should look familiar.

There’s less than a year before ICD-10 goes into effect and now’s the time to get to know the codes for diagnoses you commonly see and how they’ll change in 2015. If your providers treat patients with high blood pressure, you can breathe a sigh of relief that the coding of hypertensive heart disease in ICD-10 is very similar to ICD-9. 

Good news: You’ll no longer need to declare whether the diagnosis is malignant, benign, or unspecified. Get the lowdown on the ICD-10 updates so you’re prepared next fall. 

Continue to Rely on Notes

In order to code for hypertension, you have to refer to your physician’s records. Hypertension is a numeric five-character code, classified in ICD-9 under the hypertensive disease category with five subcategories. You need to know if the hypertension is malignant, benign, or unspecified for each of the five subcategories. The fourth digit of the code signifies whether the hypertension is malignant, benign, or unspecified. You have the following ICD-9 codes to choose from: 

• 401 — Essential hypertension

       o 401.0 — Malignant essential hypertension
       o 401.1 — Benign essential hypertension
       o 401.9 — Unspecified essential hypertension

• 402 — Hypertensive heart disease

       o 402.0 — Malignant hypertensive heart disease
       o 402.1 — Benign hypertensive heart disease
       o 402.9 — Unspecified hypertensive heart disease

• 403 — Hypertensive renal disease

       o 403.0 — Malignant hypertensive renal disease
       o 403.1 — Benign hypertensive renal disease
       o 403.9 — Unspecified hypertensive renal disease

• 404 — Hypertensive heart and renal disease

        o 404.0 — Malignant hypertensive heart and renal disease
        o 404.1 — Benign hypertensive heart and renal disease
        o 404.9 — Unspecified hypertensive heart and renal disease

• 405 — Secondary hypertension

        o 405.0 — Malignant secondary hypertension
        o 405.1 — Benign secondary hypertension
        o 405.9 — Unspecified secondary hypertension.

Tip: Avoid coding 401.0 for a patient who once had, but may no longer have, malignant hypertension once he is released to go home.

Prepare to Implement the New Codes

The difference between coding hypertensive disease with ICD-9 from ICD-10 is that you won’t need to make the malignant, benign, or unspecified distinction with ICD-10. What doesn’t change is that both ICD-9 and ICD-10 subcategories mention the organ involvement in their descriptors.

Future ICD-10: The codes will go to an alphanumeric five-character code (I10-I15) and will be classified under the hypertensive diseases category with five subcategories as follows:

• I10 — Essential (primary) hypertension
• I11 — Hypertensive heart disease

            o I11.0 — Hypertensive heart disease with heart failure
            o I11.9 — Hypertensive heart disease without heart failure

• I12 — Hypertensive chronic kidney disease

            o I12.0 — Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
            o I12.9 — Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease

• I13 — Hypertensive heart and chronic kidney disease

           o 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
           o I13.1 — Hypertensive heart and chronic kidney disease without heart failure
           o 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
           o I13.11 — Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
           o I13.2 — a Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease

• I15 — Secondary hypertension.

Crosswalk: Essential hypertension will go from 401.x in ICD-9 to I10 in ICD-10.

Tip: Visiting the CMS site for new information to do with your preparation is still a good idea. Take a look at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2014-Transmittals.html# and filter on “ICD-10” to see the latest transmittals.

Be Heard in Order to Avoid Another Delay

Physician groups have sent requests to Congress to delay the implementation of ICD-10 until 2017. To see what these groups are asking Congress, visit journal.ahima.org and search on ICD-10.

According to CMS, the healthcare industry lost approximately 6.8 billion dollars as a result of the last delay. Losses included investments and missed opportunities for better health data to improve quality of care and patient safety.

Be proactive: If you don’t want to see another delay, contact your public officials and ask them to support the Oct. 1, 2015 compliance date and to vote “no” on any additional delays. You can contact your legislators using American Health Information Management Association’s (AHIMA) advocacy tools by visiting capwiz.com/ahima/home.