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Reader Question:

Confirm Link Before Reporting Hypertensive Heart Disease

Published on Sun Jan 16, 2011

Question: Our new patient has chronic kidney disease (CKD) stage III, congestive heart failure (CHF), cardiomyopathy and malignant hypertension. The physician states that the kidney failure is related to the hypertension, but doesn't indicate whether the heart disease is related. Can we list a 404.xx code for this patient?

Minnesota Subscriber

Answer: While you can't assume a link between hypertension and heart disease, there are some clues in this situation that your patient does have hypertensive heart disease. The fact that his hypertension is malignant and that he has cardiomyopathy could indicate a link.

Ask the physician whether the patient has hypertensive cardiomyopathy and hypertensive heart failure. If the physician confirms your suspicions, then you can use a 404.x (Hypertensive heart and renal disease) code to indicate that the patient has both hypertensive kidney disease and hypertensive heart disease rather than reporting both a 402.x (Hypertensive heart disease) and a 403.x (Hypertensive renal disease) code.

If the physician confirms the link between your patient's hypertension and his heart disease, you'll list the fourth digit "0" for "malignant," and the fifth digit "1" for "with

heart failure and with chronic kidney disease stage I through stage IV, or unspecified," so, your final code is 404.01 Your ICD-9 manual will instruct you to also code the type of heart failure and the stage of chronic kidney disease for this patient, so, follow 404.01 with:

  • 428.0 (Congestive heart failure, unspecified);
  • 425.x (Cardiomyopathy); and
  • 585.3 (Chronic kidney disease, Stage III [moderate]).

If you can't confirm hypertensive heart disease for this patient, code for the hypertension with 403.00 (Hypertensive chronic kidney disease; malignant; with chronic kidney disease, Stage I-IV or unspecified).

Sequence 585.3 (Chronic kidney disease, Stage III) after the 403.xx code in either case. Code for your patient's cardiac issues according to seriousness. These codes do not have to follow the hypertension code if you cannot confirm the hypertensive heart disease.

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