Home Health & Hospice Week

You can capture case mix points with HTN codes in these circumstances.

While the 401.1 and 401.9 hypertension codes no longer earn case mix points, there are still case mix points to be earned in the HTN category.

The combination hypertension codes 402.x (Hypertensive heart disease), 403.x (Hypertensive renal disease) and 404.x (Hypertensive heart and renal disease) can earn case mix points under the home health prospective payment system. But these diagnoses must be validated by the physician or designee, cautions consultant Lynda Laff with Laff Associates in Hilton Head Island, S.C.

Beware: Even though 401.0 (Malignant essential hypertension) remains case mix, its use should be rare in the home care setting, says attorney and coding expert Lisa Selman-Holman of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas. Malignant hypertension is most often treated in the acute facility, although there are a few of these patients at home. You may only code malignant hypertension if the physician specifically documents "malignant." No other adjective, such as "uncontrolled" applies, she says.

Know the Assumption Rules

For patients who do have confirmed hypertension and chronic kidney disease or heart disease diagnoses, there is a coding rule quirk of which you must be aware. You can presume a relationship between chronic kidney disease and hypertension, Selman-Holman says. So you can look to the 403.x codes when your patient has hypertension with chronic kidney disease (585) or renal sclerosis (587).

But you can't presume a relationship between heart disease and hypertension. The physician must either state that there is a link (e.g., heart failure due to hypertension) or imply the relationship (e.g., hypertensive heart disease) before you can report a 402.x or 404.x code, Selman-Holman says. Heart conditions with hypertension are not automatically coded as hypertensive heart disease with a 402.x category code.

Bottom line: Clinicians and coders should make sure they are educated on the proper use of codes 402.x and 403.x codes, Laff says. And remember, these codes require a fifth digit.

Note: For more tips and strategies on accurate diagnosis coding, subscribe to Eli's Home Health ICD-9 Alert at www.elihealthcare.com.