ICD 10 Coding Alert

Your documentation no longer needs to distinguish this attribute.

The ICD-10 implementation date has been officially postponed, according to a Feb. 16 statement from the Dept. of Health and Human Services (HHS). Although a new date hasn't been announced, you can take advantage of the extra time to ensure your practice has all of its preparations in place for the new coding and documentation requirements. Continue your training with this look at coding for hypertensive heart disease.

The diagnosis: In hypertensive heart disease, hypertension leads to heart disease. As the codes indicate, heart failure may or may not be present.

ICD-9 codes:

• 402.0x, Hypertensive heart disease; malignant
• 402.1x, Hypertensive heart disease; benign
• 402.9x, Hypertensive heart disease; unspecified

Fifth digit options:

• 0, ... without heart failure
• 1, ... with heart failure

• I11.0, Hypertensive heart disease with heart failure
• I11.9, Hypertensive heart disease without heart failure

ICD-9 coding rules: The terms "benign" and "malignant" in the ICD-9 hypertensive heart disease codes can cause problems. If physicians don't include those terms in their hypertension documentation, coders are left with an "unspecified" code as the only compliant option.

A second coding requirement for ICD-9 is that you should report the heart failure type (428.x, Heart failure), if applicable and if known.

ICD-10 changes: ICD-10 simplifies coding by eliminating the terms benign and malignant from your choices.

Under ICD-10, your coding will still vary based on heart failure (I11.0) or no mention of heart failure (I11.9). As with ICD-9, you should use an additional code to report the heart failure type, when present.

Documentation: For coding purposes, documentation will no longer need to distinguish between benign and malignant hypertension. But if you're reporting I11.0, you will need to see the heart failure type so you may code it, as well (I50.-).

Inform providers that for both ICD-9 and ICD-10, hypertensive heart disease codes apply only when documentation states or implies a causal relationship between the two. For example, the documentation may state the heart disease is "due to hypertension" or imply the relationship by calling the heart disease "hypertensive." For instance, ICD-10 instructs that the issues described by heart disease codes I51.4-I51.9 should be coded to I11.- when due to hypertension. If there's no documented relationship, you should report the heart disease and hypertension separately.

Coder tips: A note under I11.9 states it's appropriate for hypertensive heart disease NOS (not otherwise specified), so it is appropriate if there's no mention of heart failure in the documentation.

You'll also avoid confusion if you alert everyone involved with coding to expect ICD-10 codes to begin with a letter followed by digits. In this case, the code begins with the letter "I" followed by the number "11." The similarities between letter "I" and number "1" could cause a mix-up.