Home Health ICD-9/ICD-10 Alert

Linking hypertension no longer limited to cases of renal failure.

Get ready for new descriptors and fifth digits for hypertensive renal and heart disease codes. These changes, effective Oct. 1, should increase your coding accuracy for these conditions--and help speed payment for these claims.

Welcome 403 and 404 Series Makeovers

In the 403.xx series, the Centers for Medicare & Medicaid Services revised the descriptor "hypertensive renal disease" to "hypertensive kidney disease." Now the fifth digits define with and without mention of "renal failure." As of Oct. 1, fifth-digit "0" will represent "without chronic kidney disease," while fifth- digit "1" will describe "with chronic kidney disease."

CMS has changed the 404.xx series code descriptor from "hypertensive heart and renal disease" to "hypertensive heart and kidney disease."

You should note the two revised fifth digits, as well. The changes are as follows:

• 0--without heart failure or chronic kidney disease. The current descriptor reads, "without mention of heart failure or renal failure." 

• 2--with chronic kidney disease. CMS deleted the "with renal failure" definition.

"Prior to this change, the term 'without mention of' indicated that documentation didn't clarify whether or not the patient had heart failure or kidney disease," says Margaret W. Rush, RHIA, HCS-D, with Alacare Home Health & Hospice in Birmingham, AL. Now, you can use the revised fifth digits to indicate specifically whether or not the patient has heart failure or kidney disease, according to the record.

These changes open up hypertensive codes to more patients. Formerly you could use the hypertensive renal disease ICD-9 codes only for patients who had kidney failure or renal sclerosis, even though more patients have hypertension caused by chronic kidney insufficiency, says Tara Conklin, CPC, an independent coding consultant in Wesley Chapel, FL.

"This is another welcome expansion of current ICD-9 codes," says Conklin. "With the expansion of these codes, linking hypertension caused by renal disease is no longer limited to patients with renal failure."

Helpful: With these revisions, you no longer have to use a code from the 401.x series (Essential hypertension) in addition to a code from the 593.x series (Other disorders of kidney and ureter) when you're coding a hypertension diagnosis caused by renal insufficiency, Conklin says. Instead, you'll need only one specific code.