ICD 10 Coding Alert
Get Your Hypertension Coding Under Control
Know which HTN cases call for the use of a combination code. Many coders have coded at least a few cases of hypertension (HTN). It can be a tricky condition to code, though, because of its complexity and potential relationship to other diseases. The key to accurate reporting is understanding these conditions, the combination codes, ICD-10-CM guidelines, and the documentation required. Here are some more fast facts to keep your hypertension coding in tip-top shape. Know Uncontrolled HTN Can Cause Other Diseases Hypertension occurs when the force/pressure of the blood against the arterial walls is too high, says Julie-Leah J. Harding, CPC, CPMA, CEMC, CCC, CRC, RMC, PCA, CCP, SCP-ED, CDIS, AHIMA-approved ICD-10 trainer and ambassador and director of clinical compliance-cardiovascular surgery at Boston Children’s Hospital in Boston, Massachusetts. Early detection and proper management of HTN are crucial, as chronically elevated blood pressure can increase the chances that heart, brain, kidney, and other diseases may arise. Code Hypertensive Heart Disease Like This If the documentation indicates the patient has hypertensive heart disease — HTN that has resulted in a heart condition classified under I50.- (Heart failure), I51.4 (Myocarditis, unspecified)-I51.7 (Cardiomegaly), I51.89 (Other ill-defined heart diseases), or I51.9 (Heart disease, unspecified) — report the appropriate code from category I11.- (Hypertensive heart disease), according to the ICD-10-CM guidelines: Coding tip: Pay close attention to the multiple “code also” and “use additional code notes” for hypertension. If the patient has heart failure, be sure to report an additional code from category I50.- to identify the exact type of heart failure. Possible options include I50.22 (Chronic systolic (congestive) heart failure), I50.32 (Chronic diastolic (congestive) heart failure), and I50.814 (Right heart failure due to left heart failure). However, if the physician documents that the heart condition (I50.-, I51.4-I51.7, I51.89, I51.9) is not related to the patient’s HTN, instead report those conditions separately and sequence according to the circumstances of the encounter. Remember to Report CKD Stage for Hypertensive CKD If the provider documentation indicates that the patient has hypertensive chronic kidney disease (CKD) — HTN that has resulted in a renal condition that falls under category N18.- (Chronic kidney disease (CKD)) — submit the appropriate combination code from category I12.- (Hypertensive chronic kidney disease) instead of using two separate codes. On the other hand, you should not code CKD as hypertensive if the provider indicates the kidney disease is not related to the hypertension, according to the guidelines. Secondary code: When you use a code from category I12.-, you should also report a secondary code from category N18.- to indicate the stage of CKD, which correlates to disease severity: In the early stages (stages 1-3), the kidneys are still able to filter waste out of the blood. In the later stages (stages 4-5), the patient’s kidneys must work harder to filter their blood and may stop working altogether. Coding tip: “If both a stage of CKD and ESRD are documented, assign code N18.6 only,” per guideline I.C.14.a.1. Look to Catego ry I13.- Codes for Hypertensive Heart and CKD If the patient has hypertension with both heart and kidney involvement, report a code from category I13.- (Hypertensive heart and chronic kidney disease). If your provider documents the presence of heart failure, be sure to include the appropriate code from category I50.- to identify the exact type of heart failure. Don’t miss: When using a code from category I13.-, you must also report the appropriate code from category N18.- as a secondary code to identify the stage of CKD, per the guidelines. Coding tip: Category II3.- is a combination category for hypertensive heart disease and CKD. If a patient has all three conditions, hypertension, heart disease, and CKD, report a code from category I13.-. Do not submit individual codes for hypertension, heart disease, and CKD, or codes from categories I11.- or I12.-. If the patient has both acute renal failure and CKD, you should also document the appropriate code for acute renal failure and sequence according to the circumstances of the encounter. “In order for the coder to be able to collect the details needed for selecting the correct codes for hypertension, the provider must document if the patient has congestive heart failure and/ or kidney disease,” says Carol Hodge, CPC, CPMA, CDEO, CCC, CEMC, CPB, CFPC, COBGC, senior documentation specialist at St. Joseph’s/Candler Medical Group. “If so, then the provider needs to document the type of heart failure and/or the stage of kidney disease.” Key: Code these conditions as related even in the absence of provider notes explicitly linking them unless the documentation clearly states the conditions are unrelated. Submit 2 Codes for Hypertensive Cerebrovascular Disease Elevated blood pressures increase the risk of cerebrovascular diseases such as stroke and dementia. When coding hypertensive cerebrovascular disease, first assign the applicable code from categories I60.- (Nontraumatic subarachnoid hemorrhage) through I69.- (Sequelae of cerebrovascular disease), followed by the appropriate HTN code. Grasp Hypertensive Retinopathy Reporting Requirements Long-term high blood pressure can also cause damage to the retina. When reporting hypertensive retinopathy, first choose a code from subcategory H35.0- (Background retinopathy and retinal vascular changes), according to the guidelines. For the second code, select the appropriate code from categories I10.- (Essential (primary) hypertension) through I15.- (Secondary hypertension) to indicate the type of hypertension. The sequencing of these two codes is based on the reason for the encounter.
o N18.30 (… stage 3 unspecified)
o N18.31 (… stage 3a)
o N18.32 (… stage 3b)
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