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Cardiology billing and coding comes with unique challenges such as frequent code changes, complex procedure guidelines, and varying payer rules. Knowledge about current cardiology medical billing codes and documentation and compliance updates is essential to report services correctly. ICD-10 offers specific codes that allow providers, staff, and coders to code as specifically as possible.

Causes and Symptoms

Caused mainly by high blood pressure, hypertensive heart disease is the leading cause of death for both men and women in the United States. Hypertensive heart disease is a group of disorders that includes heart failure, left ventricular hypertrophy (thickening of the heart muscle), coronary artery disease, and other conditions.

Symptoms of hypertensive heart disease vary based the severity of the condition and progression of the condition, though some patients experience no symptoms. Common symptoms include high blood pressure, enlarged heart and irregular heartbeat, fluid in the lungs or lower extremities, and unusual heart sounds. Signs that help physicians diagnose the condition include shortness of breath, chest pain (angina),tightness or pressure in the chest, fatigue, chronic cough, pain in the neck, back, arms, or shoulders, leg or ankle swelling, and nausea.

Hypertensive Heart Disease: ICD-10 Coding

ICD-10 presumes a causal relationship between hypertension and heart involvement since the two conditions are linked by the term “with” in the Alphabetic Index. The guidelines state that these conditions should be coded as related even if there is no provider documentation explicitly linking them. For hypertension and conditions not specifically linked by relational terms such as “with,” “associated with” or “due to” in the classification, provider documentation must link the conditions in order to code them as related. On the other hand, if the documentation clearly states the conditions are unrelated, they can be reported separately.

ICD-10 offers specific codes to report hypertensive heart disease and associated conditions.

Hypertension with heart conditions (such as but not limited to: cardiomegaly, heart failure, myocardial degeneration and myocarditis classified to I50. – or I51.4-I51.7, I51.89, I51.9), are assigned a combination code from category I11 – hypertensive heart disease

CategoryI11, Hypertensive heart disease has two codes to indicate if heart failure is present:

I11.0 Hypertensive heart disease with heart failure
I11.9 Hypertensive heart disease without heart failure

A note under I11.0 states: “Use additional code to identify type of heart failure (I50.-).”

The code for systolic heart failure is I50.2 and the code for diastolic heart failure is I50.3-. Combined systolic and diastolic heart failure is coded with I50.4. Fifth characters in the code further specify whether the heart failure is unspecified, acute, chronic or acute on chronic.

  • I50.1, Left ventricular failure, unspecified
  • I50.2, Systolic (congestive) heart failure
  • I50.3, Diastolic (congestive) heart failure
  • I50.4, Combined systolic (congestive) and diastolic (congestive) heart failure

Other heart conditions that have an assumed causal connection to hypertensive heart disease:

  • I50.810, Right heart failure, unspecified
  • I50.811, Acute right heart failure
  • I50.812, Chronic right heart failure
  • I50.813, Acute on chronic right heart failure
  • I50.814, Right heart failure due to left heart failure
  • I50.82Biventricular heart failure
  • I50.83 High output heart failure
  • I50.84, End-stage heart failure
  • I50.89, Other heart failure
  • I50.9, Unspecified

First, report code I11.0, hypertensive heart disease with heart failure as instructed by the note at category I50, heart failure. Report an additional code from category I50- heart failure to specify the type of heart failure. To assign the most specific code from category I50, the documentation needs to indicate the type of heart failure. For example:

  • Congestive heart failure due to hypertension: I11.0 + I50.9
  • Hypertensive heart disease with congestive heart failure: I11.0 + I50.9

A diagnosis of left ventricular, biventricular and end-stage heart failure requires two codes to completely describe the condition: one to identify the left, biventricular or end-stage heart failure, and one to report the type of heart failure.

When the heart condition is unrelated to hypertension: If the provider specifically documents a different cause for the hypertension and the heart condition, the heart condition (I50.-, II51.4-I51.9) and hypertension should be coded separately and the combination code is not used. In such cases, the codes should be sequenced according to the circumstances of the admission/encounter. AAPC provides the following example:

For a patient discharged with a diagnosis of exacerbated chronic diastolic congestive heart failure and a secondary diagnosis of hypertension, the codes to report are:

I11.0 Hypertensive heart disease with heart failure

I50.32 Chronic diastolic (congestive) heart failure

Code Tobacco Use or Exposure: Code tobacco use if documented. An instructional note provided for categories I11 states to use an additional code to identify exposure to environmental tobacco smoke (Z77.22), history of tobacco use (Z87.891), occupational exposure to environmental tobacco smoke (Z57.31), tobacco dependence (F17-) or tobacco use (Z72.0). For example:

I11.0 Hypertensive heart disease with heart failure

I50.32 Chronic diastolic (congestive) heart failure

Z87.891 History of tobacco use

Ensure Proper Clinical Documentation: Good clinical documentation is essential to code to the highest level of patient specificity. The documentation should include the status of the patient and the type of hypertension being treated and findings to support the diagnosis of hypertension and the current manifestations when applicable. Secondary diagnoses, such as systolic/diastolic heart failure and/or chronic kidney disease should be documented. A valid treatment plan should be documented in the form of: medication, referral, diet, monitoring, and/or ordering a diagnostic exam. Appropriate blood pressure targets must be clearly stated in the treatment plan.

Coding for hypertension requires attention to detail and a proper understanding of the ICD-10 guidelines. Medical billing and coding outsourcing to an experienced provider can ensure accurate coding and compliance for accurate claims submission and appropriate reimbursement.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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