Coding Spotlight: Hypertension A Providers Guide For Coding
Jul 1, 2019State & Federal / Medicaid
Category:
- Hypertensive crisis can involve hypertensive urgency or emergency.
- Hypertension can occur with heart disease, chronic kidney disease or both.
- ICD-10-CM classifies hypertension by type as essential or primary and secondary .1
- Categories I10-I13 classify primary hypertension according to a hierarchy of the disease from its vascular origin to the involvement of the heart , CKD , or heart and CKD combined .1
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Hypertensive heart disease with heart failure |
|
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I11.9 |
Hypertensive heart disease without heart failure |
|
I12.0 |
Hypertensive CKD with stage 5 CKD or end-stage renal disease |
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I12.9 |
Hypertensive CKD with stage 1 through stage 4 CKD or unspecified CKD |
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I13.0 |
Hypertensive heart and CKD with heart failure and stage 1 through stage 4 CKD or unspecified CKD |
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I13.10 |
Hypertensive heart and CKD without heart failure with stage 1 through stage 4 CKD or unspecified CKD |
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I13.11 |
Hypertensive heart and CKD without heart failure with stage 5 CKD or ERSD |
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I13.2 |
Hypertensive heart and CKD with heart failure and with stage 5 CKD or ERSD |
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I15.- |
Hypertensive heart disease
Category I11 is subdivided to indicate whether heart failure is present. However, an additional code from category I50 is required to specify the type of heart failure, if known.
Documentation may vary, but coding instructions remain the same. For example:
Other heart conditions that have an assumed causal connection to hypertensive heart disease:
Hypertension and CKD
Hypertensive Heart And Chronic Kidney Disease Without Heart Failure
- 20162017201820192020202120222023Non-Billable/Non-Specific Code
- I13.1 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.
- Short description: Hypertensive heart and chronic kidney disease w/o hrt fail
- The 2023 edition of ICD-10-CM I13.1 became effective on October 1, 2022.
- This is the American ICD-10-CM version of I13.1 – other international versions of ICD-10 I13.1 may differ.
- Applicable To annotations, or
Hypertensive Heart And Chronic Kidney Disease With Heart Failure And Stage 1 Through Stage 4 Chronic Kidney Disease Or Unspecified Chronic Kidney Disease
- 20162017201820192020202120222023Billable/Specific Code
- I13.0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
- Short description: Hyp hrt & chr kdny dis w hrt fail and stg 1-4/unsp chr kdny
- The 2023 edition of ICD-10-CM I13.0 became effective on October 1, 2022.
- This is the American ICD-10-CM version of I13.0 – other international versions of ICD-10 I13.0 may differ.
“use additional code”
- code to identify type of heart failure (ICD-10-CM Diagnosis Code I50
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Hypertensive Heart Disease With Heart Failure
- 20162017201820192020202120222023Billable/Specific Code
- I11.0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
- The 2023 edition of ICD-10-CM I11.0 became effective on October 1, 2022.
- This is the American ICD-10-CM version of I11.0 – other international versions of ICD-10 I11.0 may differ.
“use additional code”
- code to identify type of heart failure (ICD-10-CM Diagnosis Code I50
Coding For Secondary Htn
Some patients have high blood pressure caused by another medical condition such as those that affect the kidneys, arteries, heart, or endocrine system. In these cases, the ICD-10-CM HTN codes discussed above cannot be used. Instead, turn to the codes in category I15 Secondary hypertension. The five secondary hypertension codes require that you also code the underlying condition. The first-listed code is determined based on the reason for the patient encounter.
Example: A patient is being seen for blood pressure management. The provider documents acromegaly a hormonal disorder that develops when the pituitary gland produces too much growth hormone during adulthood with secondary hypertension. Codes reported:
I15.2 Hypertension secondary to endocrine disorders
E22.0 Acromegaly and pituitary gigantism
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Diseases Of The Circulatory Systemtype 2 Excludes
- hypertensive disease complicating pregnancy, childbirth and the puerperium
- exposure to environmental tobacco smoke
- history of tobacco dependence
- occupational exposure to environmental tobacco smoke
- 20162017201820192020202120222023Non-Billable/Non-Specific Code
Includes
- Benign hypertensive heart disease
- Hypertensive heart and kidney disease
- Hypertensive heart disease
- Malignant hypertensive heart disease without congestive heart failure
- Preexisting hypertensive heart disease in childbirth
- Preexisting hypertensive heart disease in pregnancy
- Preexisting hypertensive heart disease, postpartum
- Preexisting hypertensive heart disease, postpartum
- 304 Hypertension with mcc
- Hypertension, hypertensive I10ICD-10-CM Diagnosis Code I10
- 20162017201820192020202120222023Billable/Specific CodeQuestionable As Admission Dx
Includes
- hypertensive disease complicating pregnancy, childbirth and the puerperium
Hypertensive Heart And Chronic Kidney Disease Without Heart Failure With Stage 1 Through Stage 4 Chronic Kidney Disease Or Unspecified Chronic Kidney Disease
- 20162017201820192020202120222023Billable/Specific Code
- I13.10 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
- Short description: Hyp hrt & chr kdny dis w/o hrt fail, w stg 1-4/unsp chr kdny
- The 2023 edition of ICD-10-CM I13.10 became effective on October 1, 2022.
- This is the American ICD-10-CM version of I13.10 – other international versions of ICD-10 I13.10 may differ.
- Hypertensive heart disease and hypertensive chronic kidney disease NOS
“use additional code”
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Coding Hypertensive Heart And Ckd
If a patient has all three conditions documented HTN, heart disease, and CKD look to combination category I13 for code assignment. Codes for the three-disease combination are numerically arranged by the degree of CKD and then further differentiated by the presence or absence of heart failure.
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
As with the two-disease combination codes, all of the three-disease combination codes require additional coding from category N18 to identify the stage of kidney disease. The three-combination codes that include heart failure also require an additional code from the I50 series to specify the type and acuity of the failure.
I13.0 Hypertensive heart and chronic kidney disease with heart failure and with stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease
I50.21 Acute systolic heart failure
N18.32 Chronic kidney disease, stage 3b
Coding Tip: Hypertension With Heart Involvement In Icd
Kim Boy, RHIT, CDIP, CCS, CCS-P
This Coding Tip was updated on 12/10/2018
The word with is sequenced immediately following the main term in the Alphabetic Index and not in alphabetical order.
The classification presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement, as the two conditions are linked by the term with in the Alphabetic Index. Even in the absence of provider documentation explicitly linking them, these conditions should be coded as related.
Hypertension with heart conditions classified to I50.-or I51.4-I51.9. are assigned a code from category I11, Hypertensive heart disease. If the provider specifies a different cause then they would be coded separately and not linked. This would be the same if the physician gives another etiology for the CKD. It is an assumed link when NO other cause has been documented.
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Keys To The Right Diagnosis Coding
Diagnosis coding is the forgotten stepchild in medical practices.
Physician coding has focused on Current Procedural Terminology codes, which drives revenue when services are provided under a fee-for-service model. Diagnosis coding, in contrast, establishes the medical necessity for the service, and can be the reason a claim is denied, particularly for diagnostic tests and other services with payer coverage policies. However, as payment for healthcare services morphs into payment based on utilization, quality, and outcomes, accurately reporting the severity of a patient’s conditions is important for physician practices.
Coding for hypertension, hypertensive heart disease, and hypertensive chronic kidney disease hasn’t changed much from the ninth edition of the International Classification of Diseases to the tenth edition . However, too few physicians select the more specific, risk-adjusted codes in ICD-9. The change to ICD-10 provides the opportunity to more accurately report these conditions. The most specific codes in ICD-10 enable a physician communicate the severity of the patient’s condition to the payer.
Essential hypertension in ICD-10 has only one code: I10. Coders joke that it is the one code they can easily memorize, because a complete ICD-10 code can be up to seven characters long and is alphanumeric. Both 401.1 and 401.9 will be replaced by I10essential hypertension.
Coding Hypertensive Chronic Kidney Disease
When the diagnostic statement includes both HTN and a condition classifiable to category N18 Chronic kidney disease, ICD-10-CM presumes a causal relationship and categorizes the condition as hypertensive chronic kidney disease . Use a code from category I12 to describe these two related disorders, even in the absence of documentation linking them. A fourth character is used with category I12 to indicate the stage of CKD.
Sequence first the I12 code for the combined diagnosis of HTN with CKD:
I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
These two codes also require that you report a secondary code from category N18 to identify the stage of kidney disease, with documentation typically referencing the most recent estimated glomerular filtration rate the best test to measure the level of kidney function and determine the stage of renal disease.
In cases where the documentation clearly states the CKD is not related to the HTN, the conditions should be coded separately. The guidelines further specify that if a patient has hypertensive chronic kidney disease and acute renal failure, an additional code for acute renal failure is required.
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
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Hypertensive Heart And Chronic Kidney Disease
- 20162017201820192020202120222023Non-Billable/Non-Specific Code
- I13 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.
- The 2023 edition of ICD-10-CM I13 became effective on October 1, 2022.
- This is the American ICD-10-CM version of I13 – other international versions of ICD-10 I13 may differ.
- any condition in
- I11.0 Hypertensive heart disease with heart failure…
- I11.9 Hypertensive heart disease without heart fail…
- I12 Hypertensive chronic kidney disease
- I12.0 Hypertensive chronic kidney disease with stag…
- I12.9 Hypertensive chronic kidney disease with stag…
- Applicable To annotations, or
Hypertensive Heart Disease Without Heart Failure
- 20162017201820192020202120222023Billable/Specific Code
- I11.9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
- The 2023 edition of ICD-10-CM I11.9 became effective on October 1, 2022.
- This is the American ICD-10-CM version of I11.9 – other international versions of ICD-10 I11.9 may differ.
- Applicable To annotations, or
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Example Of Hypertension And Heart Involvement:
- Patient is discharged with final diagnosis of exacerbated CHF, and a secondary diagnosis of hypertension. For this patient, CHF and hypertension would be coded as code I11.0, Hypertensive heart disease with heart failure since the causal relationship is assumed due to the word with following the main term in the Alphabetic Index under hypertension. Since the heart disease falls within the code range of I50.- or I51.4-I51.9 the link would be assumed. Additional code for the type of heart failure would be assigned as a secondary diagnosis, I50.9. This was verified at the AHIMA Coding Community meeting in Baltimore, MD on October 15, 2016 by Nelly Leon-Chisen.
- Patient is discharged with final diagnosis of atherosclerotic heart disease with unstable angina and hypertension. For this patient, the causal relationship would not be linked because the heart disease does not fall within the code range listed for the causal effect to be assumed. CAD falls within the code range of I25.-. The code range for the assumed link is I50.- or I51.4-I51.9 only.
References
Not Valid For Submission
402.10 is a legacy non-billable code used to specify a medical diagnosis of benign hypertensive heart disease without heart failure. This code was replaced on September 30, 2015 by its ICD-10 equivalent.
| ICD-9: | |
| Benign hyp ht dis w/o hf | |
| Long Description: | Benign hypertensive heart disease without heart failure |
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Paint An Accurate Picture Of Illness Severity By Knowing Which Clinical Details Influence Code Selection For Hypertension And Common Comorbid Conditions
Hypertension is the medical term for elevated blood pressure a serious medical condition in which the pressure of the circulating blood against the arterial walls is high enough that it may eventually cause health problems such as hypertensive heart disease and stroke. Hypertension is a worldwide epidemic, affecting an estimated 1.13 billion people globally and nearly half of all adults in the United States. Thats roughly 108 million Americans, and only about one in four have their blood pressure under control.
Coding for hypertension requires attention to detail and a solid understanding of the ICD-10-CM Official Guidelines for Coding and Reporting. One concept integral to proper coding of high blood pressure is guideline I.A.15, which states that the words with and in in ICD-10-CM should be interpreted to mean associated with and due to when either appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. A causal relationship between the two conditions is presumed when they are linked by these terms in the code book.
Lets practice applying this concept to arrive at the correct codes for reporting different clinical scenarios involving patients with HTN.
Coding Hypertensive Heart Disease
Hypertensive heart disease can cause serious health problems and is the No. 1 cause of death associated with HTN. It refers to heart conditions caused by elevated blood pressure. The heart working under increased pressure causes a variety of cardiac disorders including heart failure, coronary artery disease, and thickening of the heart muscle .
A code from category I11 Hypertensive heart disease is assigned when an individual has hypertensive heart disease HTN with cardiac condition, classified to I50.- or I51.4I51.9. Since ICD-10-CM presumes a causal relationship between HTN and cardiac involvement, a combination code is used to reflect that theyre related even if there is no provider documentation linking them.
Category I11 is subdivided to indicate whether heart failure is present:
I11.0 Hypertensive heart disease with heart failure
I11.9 Hypertensive heart disease without heart failure
When a patient has heart failure and HTN, code first I11.0 as instructed by the note at category I50 Heart failure. An additional code from category I50 is required to specify the type of heart failure, if known. In cases where the type of heart failure is not identified, report I50.9 Heart failure, unspecified. The codes for systolic, diastolic, and combined heart failure also require a fifth digit to specify the acuity of the diagnosis:
0 Unspecified
2 Chronic
3 Acute on chronic
I11.0 Hypertensive heart disease with heart failure
I50.32 Chronic diastolic heart failure
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Dont Forget To Code Tobacco Use Or Exposure
All of the HTN codes require an additional ICD-10-CM code, such as F17 Nicotine dependence, if the patient is a current or former tobacco user. If there is no documentation that a patient who uses tobacco is dependent, then you would instead use the code for tobacco use . Occupational and environmental exposure to tobacco should also be reported if the provider believes these are influencing the patients health status. Codes include:
Z57.31 Occupational exposure to environmental tobacco smoke
Z77.22 Contact with and exposure to environmental tobacco smoke
Z87.891 Personal history of nicotine dependence
Coding High Blood Pressure
ICD-10-CM classifies HTN by type as essential or primary and secondary . Report code I10 Essential hypertension for individuals who meet the criteria for hypertension and do not have any comorbid cardiac or renal disease. This code includes high blood pressure but is not meant to be used when elevated blood pressure is noted in an individual that has not been diagnosed with HTN. Report cases of transient HTN with R03.0 Elevated blood-pressure reading, without diagnosis of hypertension.
If HTN progresses to the point where its affecting a body system, combination codes come into play. Specifically, the code set addresses Hypertensive heart disease with category I11, Hypertensive chronic kidney disease with category I12, and Hypertensive heart and chronic kidney disease with category I13.
When assigning diagnosis codes for HTN, there is a presumptive cause-and-effect relationship between HTN and heart involvement and between HTN and kidney involvement, as the two conditions are linked by with in the Alphabetic Index. ICD-10-CM Guideline I.C.9.a instructs that even in the absence of provider documentation explicitly linking them, these conditions should be coded as related unless the documentation clearly states the conditions are unrelated.
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Basic Information On Hypertension Icd 10 Code
If you read the title, this will be the most common and confused coding scenario for medical coders. If you are fresher you will know Hypertension ICD 10 code but you will surely have lot of questions on when to code hypertension with heart disease, hypertension with kidney disease and when to code all of them together. Since these diseases are very closely linked with each other, we will be having problem for coding them. In Medical coding certification exam like CPC, there are questions from these topics and it is very important to know how to code such conditions. Now, let us learn how to deal with these scenarios and clear your confusions
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