Home Health ICD-9/ICD-10 Alert

Know what comes first when coding for hypertension.

Coding correctly for a patient with hypertension can take several codes. Try your hand at these coding scenarios to see if you know how to report this condition accurately.

Scenario #1: Your patient has benign hypertensive chronic kidney disease with end-stage renal disease.

Scenario #2: Your patient has benign hypertensive heart disease with congestive heart failure.

Answer to scenario #1: Report 403.11 (Hypertensive chronic kidney disease; benign; with end stage renal disease) and 585.6 (Chronic kidney disease; end stage renal disease), says Charlotte Lefert, RHIA, an independent health information management consultant based in Madison, WI.

You need one code to describe the patient's hypertensive chronic kidney disease and a second code to identify the stage of the chronic kidney disease, Lefert says. The fourth digit in the code for hypertension indicates whether the hypertension is stated as malignant, benign or unspecified.

List a code from category 403.X (Hypertensive chronic kidney disease) for patients who have hypertension with chronic kidney disease (CKD) (category 585.X); renal failure, unspecified (category 586); or renal sclerosis, unspecified (category 587), Lefert says. In ICD-9 these conditions have an automatic cause-and-effect relationship.

Watch for changes: In October 2008 the "includes" notes for category 403.X will include only conditions classifiable to 585 and not 586 and 587.

In category 403, you'll assign a fifth digit of "0" or "1" to indicate the stage of chronic kidney disease, Lefert says. When hypertension and chronic kidney disease are documented, you'll also need to include a second code to indicate the staging of the CKD, even if the stage is unknown. In this case, you'll use a code from category 585. Sequence this code after the 403 code.

Answer to scenario #2: List 402.11 (Hypertensive heart disease, benign, with heart failure) for the hypertension. You will also need to report an additional code -- 428.0 (Congestive heart failure; unspecified) to specify the type of heart failure your patient has, Lefert says.

When reporting hypertension with heart disease (conditions in 425.8, 429.0-429.3, 429.89, 429.9), assign a code from category 402.X (Hypertensive heart disease) when a causal relationship is stated (due to hypertension) or implied (hypertensive) in physician documentation, Lefert says.

Use an additional code from category 428 to identify the type of heart failure in those patients with heart failure, she adds. You can assign more than one code from category 428 if the patient has systolic or diastolic failure and congestive heart failure.

For patients with the same heart conditions (425.8, 428, 429.0-429.3, 429.89, 429.9) and hypertension, but without a stated causal relationship, you'll code for each condition separately, Lefert says.

Assign a code from category 404.x (Hypertensive heart and chronic kidney disease) when both hypertensive kidney disease and hypertensive heart disease are stated in the diagnosis, Lefert says.