Home Health ICD-9/ICD-10 Alert

Question: Your patient was referred to home health for skilled nursing to assess and instruct following acute hospitalization for hypertensive emergency. The patient has a history of malignant hypertension, stage 4 chronic kidney disease, chronic atrial fibrillation, and congestive heart failure. Which ICD-10 codes would you list for him?

What would you do? Consider this scenario before turning to page 22 to see what our expert recommends.

Answer: Report the following codes for this patient, says coding expert Brandi Whitemyer, RN, COS-C, HCS-D, HCS-O, AHIMA Approved ICD-10 Trainer/Ambassador in Weslaco, Texas.

• M1021a: I12.9 (Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease);
  
• M1023b: N18.4 (Chronic kidney disease,
  
• stage 4 [severe]);
  
• M1023c: I50.9 (Heart failure, unspecified); and
  
• M1023d: I48.2 (Chronic atrial fibrillation).
  

ICD-10 does not classify “malignant” essential hypertension to a specific code, so this piece of information won’t impact your code choice, Whitemyer says.

You can assume a relationship between hypertension and CKD, and the patient’s hypertension is the focus of your care, so your primary diagnosis is I12.9.

Coding guidelines state to “use additional code to identify the stage of chronic kidney disease,” so next you’ll list N18.4 to indicate your patient has stage 4 CKD.

Follow this with I50.9 to indicate that your patient has heart failure. You don’t have a physician’s statement linking this condition to the patient’s hypertension, so you’ll code for it separately.

Finally, take note that “chronic” atrial fibrillation has a specific code in ICD-10 — I48.2, Whitemyer says.