Home Health ICD-9/ICD-10 Alert

Question: Our 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. Should we report the hypertension with 403.00 (Hypertensive chronic kidney disease; malignant; with chronic kidney disease, Stage I through IV or unspecified) or can we use 404.01 (Hypertensive heart and chronic kidney disease; malignant; with heart failure and with chronic kidney disease Stage I through stage IV, or unspecified)?

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

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

With this patient, for code 404.xx use 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, but only if the physician confirms the relationship between the hypertension and the heart condition. To code the 404 category in this scenario, the physician must agree that the patient has "hypertensive cardiopathy" or has cardiopathy due to hypertension. Unlike codes from the 404.xx category, the relationship between hypertension and CKD is automatically assumed.

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),
• 425.4 (Other primary 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 code in either case. The cardiac issues may be coded according to seriousness and do not have to follow the hypertension code if you cannot confirm the hypertensive heart disease.