Primary Care Coding Alert

You can avoid taking up your FP's valuable time if you can judge when documentation is sufficient to point you to a specific hypertension code.

Make sure you-re not overstepping your reach with these hypertension true/false answers.

Question: Your FP's documentation specifies that the patient has hypertension. You have enough information to choose an accurate ICD-9 code. True or false?

Answer: False. If your FP is in the habit of merely writing "hypertension" on the patient's record, you should point this problem out to him.

The real key to correct coding for hypertension lies with physician documentation, and you must educate your physicians to tell you explicitly what type of hypertension they-re treating, says Kristy F. Lane, CCP-P, coding practice specialist at the Heart and Vascular Group in Johnson City, Tenn. Physicians need to state the details of a patient's hypertension in the medical record.

Often, physicians will simply write -hypertension- in the diagnosis portion of their notes, which leads you to nothing but 401.9 (Essential hypertension; unspecified), says Phyllis Frazier, SCP-CA, billing supervisor for Scranton Heart Institute PC in Clarks Summit, Penn. -Many insurance carriers won't accept an unspecified code any longer,- Lane says.

Action: Explain to your FPs that adequate information for medical purposes isn't always adequate for coding purposes. They need to indicate whether a patient's hypertension is malignant or benign and also define how any other manifestations are related to the hypertension. -You-ve got a multitude of specific hypertension codes to choose from,- Lane says.

For example, the FP should not just document hypertension and renal disease, but should indicate if the patient's hypertension is causing renal disease or if the renal disease is causing hypertension.

Question 2: If your FP doesn't specify the type of hypertension, you can assume that means -benign- because that's more common. True or false?

Answer: False. When you don't know whether the hypertension is malignant or benign, you shouldn't automatically assume your FP means -benign.- -Never assume anything in coding,- Lane says.

Heads up: The hypertension table in the ICD-9 manual's index lists three possible categories into which hypertension may fall: malignant, benign, and unspecified. The fourth digit of the hypertension code you report will differ depending on which category you choose. For instance, you-ll report 401.0 for malignant essential hypertension, 401.1 for benign essential hypertension, and 401.9 for unspecified.

-A patient has malignant hypertension when he has a recent significant increase over baseline blood pressure that is associated with target organ damage. There is usually vascular damage on funduscopic examination, such as flame-shaped hemorrhages or soft exudates,- says Jerome  Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C. To diagnose malignant hypertension, papilledema must be present, Williams says. Up to 1 percent of patients with benign hypertension may develop malignant hypertension " meaning malignant hypertension can be life-threatening and may cause a stroke but is much less common than benign hypertension.

Because benign hypertension is more common, physicians often assume they are indicating benign hypertension when they simply write -hypertension.- But if the documentation doesn't specifically state -benign- or -malignant,- the only accurate choice you have is to report an unspecified code, which insurance carriers may not accept.