Primary Care Coding Alert

Question: When should I use a diagnosis of malignant hypertension? For example, if a patient has a stroke and hypertension, should I report 401.0 or 401.1? What sort of language (other than the word "malignant") should I look for in the dictation for a patient with hypertension to determine if the condition qualifies as benign or malignant?

California Subscriber

Answer: Although 401.x (Essential hypertension) contains three fourth-digit subclassification options, many family physician coders observe that they always use the same code: 401.1 (...; benign). In fact, due to the life-deteriorating disease that 401.0 describes (...; malignant), you will use the malignant diagnosis code rarely in an outpatient setting.
 
Instead, 401.0 applies to hospital patients. Malignant hypertension is a distinct type of process in which the blood pressure is rapidly and severely elevated. The high blood pressure basically kills off organs containing small arteries, such as a patient's kidneys, brain and eyes, resulting in death. A patient in such debilitation would require hospitalization. Therefore, 401.0 normally applies to patients who are in an intensive care unit or emergency room setting.
 
Of course, you should avoid using your third option, 401.9 (...; unspecified), whenever possible. Insurers may not cover unspecified diagnoses as readily as specific codes.

- Answers to You Be the Coder and Reader Questions provided by Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.; Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City; Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.; Judy Richardson, RN, MSA, CCS-P, senior consultant at Hill & Associates, a coding and compliance consulting firm based in Wilmington, N.C.; and Gregory L. Schnitzer, RN, CCS, CCS-P, CPC, CPC-H, RCC, CHC, manager of coding compliance and quality assurance for CodeRyte in Bethesda, Md.