Internal Medicine Coding Alert

ICD-10 streamlines to single diagnosis.

Many diagnoses will expand to multiple options with ICD-10 in October 2013, but that's not always the case. Essential hypertension is one diagnosis your internist might report that will actually have fewer choices with ICD-10.

Currently: ICD-9 2011 includes three diagnosis options for essential hypertension:

• 401.0 -- Essential hypertension; malignant
• 401.1 -- ... benign
• 401.9 -- ... unspecified.

ICD-10, however, includes only a single code for essential hypertension: I10 (Essential [primary] hypertension).

Bonus: Eliminating multiple diagnoses eliminates the problem of being forced to choose the "unspecified" code when documentation fails to indicate "benign" or "malignant."

Additional: When ICD-10 goes into effect, you'll need to keep an eye on documentation for tobacco exposure. ICD-10 includes an instruction to "Use additional code to identify" conditions including:

• Exposure to environmental tobacco smoke (Z77.22)
• History of tobacco use (Z87.891)
• Occupational exposure to environmental tobacco smoke (Z57.31)
• Tobacco dependence (F17.-)
• Tobacco use (Z72.0).

Alternative: Notes in both ICD-9 and ICD-10 state that the codes include "high blood pressure," but choose a different code in both sets when the physician documents an elevated reading without diagnosing hypertension. Under ICD-9, report 796.2 (Elevated blood-pressure reading, without diagnosis of hypertension). Under ICD-10, report R03.0, which will retain the same descriptor as 796.2.