Neurosurgery Coding Alert

Question: Is “white coat hypertension” a covered diagnosis? If so, what codes can we best submit to report this diagnosis?

Nebraska Subscriber

Answer: The best diagnosis code for white coat hypertension is 796.2 (Elevated blood pressure reading without diagnosis of hypertension). Per ICD-9, this category is to be used to record an episode of elevated blood pressure in a patient in whom no formal diagnosis of hypertension has been made, or as an incidental finding. The ICD-9 index lists it under transient hypertension. The ICD-10 equivalent to 796.2 is R03.0 (Elevated blood pressure reading, without diagnosis of hypertension).

What is white coat hypertension? White-coat hypertension is a condition where your physician records high blood pressure readings in the doctor’s office, but normal readings in other settings.

Report ambulatory monitoring: Your physician will record ambulatory blood pressure monitoring (ABPM) for a minimum period of 24 hours to make a diagnosis of white coat hypertension. You choose from the following codes for the ABPM:

• 93784, Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
• 93786, …recording only
• 93788, …scanning analysis with report
• 93790, …review with interpretation and report.

What Medicare says: In addition to supplying 796.2 for Medicare patients, you also have to prove that the patient meets Medicare’s criteria for white-coat hypertension. According to Medicare Claims Processing Manual, Chapter 32, Section 10, a diagnosis of white coat hypertension should be suspected when a patient has all three of the following:

• Clinic/office blood pressure greater than140/90 mm Hg on at least three separate clinic/office visits with two separate measurements made at each visit
• At least two documented separate blood pressure measurements taken outside the clinic/office that are less than 140/90 mm Hg
• No evidence of end-organ damage.