Learn About Coding for HIV Screening on This HIV Testing Day

Observed since June 27, 1995, National HIV Testing Day (NHTD) encourages people to get tested for HIV, know their status, and get linked to care and treatment. For 2019, the theme for this day is “Doing It My Way”. Human Immunodeficiency Virus or HIV is a retrovirus that weakens the human immune system, making people much more susceptible to infections and diseases. To document HIV treatments in medical claims, physicians can rely on medical billing services provided by professional companies. Medical coders in such companies will be up to date with the changing billing and coding standards.

Though HIV testing is recommended as part of routine health care, many Americans are not being tested as advised. Based on CDC reports, about 1.1 million people in the United States have HIV and one in seven of them are not aware of it. CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care.

HIV testing day is also the perfect time to offer support to people who have HIV and fight HIV stigma.

HIV Screening and Medicine

HIV screening involves blood test to check for the presence of HIV antibodies. These disease-fighting proteins react to HIV specifically and when present, indicate active infection. Though there’s no cure for HIV/AIDS, many different drugs are available to control the virus. For those with HIV, it is critical to take HIV medicine as prescribed by your doctor. HIV medicine lowers the amount of virus (viral load) in your body, and taking it every day can make your viral load undetectable. Antiretroviral therapy is an early treatment that significantly reduces the risk of developing acquired immunodeficiency syndrome (AIDS), which is the final stage of HIV infection.

To reduce the risk of getting HIV, it is recommended to limit the number of sex partners, get tested and treated for other sexually transmitted diseases and never share syringes or other equipment to inject drugs.

Medicare Coverage

Medicare covers annual HIV screenings for certain Medicare beneficiaries, who-

  • Are at age 15-65
  • Are younger than 15 or older than 65 and are at an increased risk for HIV
  • Are pregnant (you can get the screening up to 3 times during your pregnancy)

For accurate reimbursement for HIV screening, medical claims must include the correct codes.

Codes for HIV screening include

HCPCS Level II/CPT Codes

  • G0432 Infectious agent antibody detection by enzyme Immune assay (EIA) technique, qualitative or
    Semi-quantitative, multiple-step method, HIV-1 or HIV-2, screening
  • G0433 Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, antibody,
    HIV-1 or HIV-2, screening
  • G0435 Infectious agent antibody detection by rapid antibody test of oral mucosal transudate, HIV-1 or HIV-2, screening
  • G0475 HIV antigen/antibody, combination assay, screening
  • 80081 Obstetric panel (includes HIV testing)

ICD-10-CM Codes

  • Z11.4 Encounter for screening for human immunodeficiency virus [HIV]
  • Z72.51 High risk heterosexual behavior
  • Z72.89 Other problems related to lifestyle
  • Z34.00 Encounter for supervision of normal first pregnancy, unspecified trimester
    • Z34.01 – first trimester
    • Z34.02 – second trimester
    • Z34.03 – third trimester
  • Z34.80 Encounter for supervision of other normal pregnancy, unspecified trimester
    • Z34.81 – first trimester
    • Z34.82 – second trimester
    • Z34.83 – third trimester
  • Z34.90 Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
    • Z34.91 – first trimester
    • Z34.92 – second trimester
    • Z34.93 – third trimester
  • O09.90 Supervision of high risk pregnancy, unspecified, unspecified trimester
    • O09.91 – first trimester
    • O09.92 – second trimester
    • O09.93 – third trimester

Coders must make sure to submit HCPCS Level II codes such as G0475, G0432, G0433, and G0435 along with the required HIV primary diagnosis code Z11.4.

Early diagnosis is key to the successful treatment of HIV. It helps to improve the health of the patients and decrease transmission of the virus. While focusing on diagnosing and treating HIV, the services provided by an experienced medical billing company will be of great assistance for physicians.

Join hands to help spread awareness of the importance of HIV screening on this national HIV testing day.

Documenting Carpal Tunnel Syndrome with ICD-10 and CPT Codes

Carpal Tunnel Syndrome (CTS) refers to the painful condition caused by pressure on the median nerve in the wrist. The median nerve passes through the carpal tunnel, a narrow passageway in the wrist and goes into the hand. The carpal tunnel protects the median nerve and flexor tendons that bend the fingers and thumb. The median nerve also controls the muscles at the base of the thumb. This abnormal pressure on the nerve can result in pain, numbness, tingling, and weakness in the hand. Usually, this pressure develops when the tissues around the median nerve of the hand swell and press on the nerve. It could also be caused by a buildup of synovial fluid under the lining.

Left untreated, the condition can lead to weakness and lack of coordination in the fingers and thumb. Documenting this condition for reimbursement requires ICD-10 coding accuracy along with proper medical claim submission.

The ICD-10 coding system offers increased accuracy with separate codes for unspecified upper, right, and left limbs, such as:

  • G56.0 – Carpal tunnel syndrome
  • G56.00 – Carpal tunnel syndrome, unspecified upper limb
  • G56.01 – Carpal tunnel syndrome, right upper limb
  • G56.02 – Carpal tunnel syndrome, left upper limb
  • G56.03 – Carpal tunnel syndrome, bilateral upper limbs

Causes and Symptoms

Key risk factors for CTS include heredity, repetitive hand use, hand and wrist position, pregnancy as well as health conditions such as diabetes, rheumatoid arthritis, and thyroid gland imbalance. Recent research presented at the 2019 Annual Meeting of the American Academy of Orthopedic Surgeons (AAOS) found that approximately 28% of previously asymptomatic women will have gestational carpal tunnel syndrome (GCTS) in their third trimester.

Common symptoms of CTS may include numbness, itching numbness in the palm and the fingers, especially the thumb, index and middle fingers, tingling as well as pain in both hands, mainly after work or at night. Such symptoms can even spread to the arm and shoulder.

To document pain in the forearm using ICD-10 codes, laterality is crucial:

  • M79.631, pain in right forearm
  • M79.632, pain in left forearm
  • M79.639, pain in unspecified forearm

Diagnosis and Treatment

Based on the symptoms and medical history, the doctor may request any of those diagnosis tests including Tinel’s sign, Wrist flexion test (or Phalen test), X-rays, Electromyography (EMG) and nerve conduction studies, Ultrasound or MRI scans.

Treatment for CTS aims to reduce the pressure on the median nerve. Certain non-surgical alternatives would be recommended first, such as physical therapy and stretching exercises to improve blood flow to the hand and arm muscles; wrist splints that can keep the wrist straight and avoid exerting pressure on the compressed nerve; corticosteroids, steroid injections and prescription-only NSAIDs to reduce symptoms. CPT codes are used to document treatment options.

  • 20526 – Injection, therapeutic; carpal tunnel

Carpal tunnel release surgery is recommended by orthopedic surgeons only if non-surgical options do not work and if symptoms still exist. The surgery can be endoscopic or open and both the techniques are equally effective. With endoscopic repair, patients can return to work on average eight days earlier than that with open repair approach.

Open approach

  • 64721 – Neuroplasty and/or transposition; median nerve at carpal tunnel

For add-on procedures such as internal neurolysis using an operating microscope done during a carpal tunnel release using an open approach, use code

  • 64727 Internal neurolysis, requiring use of operating microscope (List separately in addition to for neuroplasty) (Do not report code 69990 in addition to code 64727)

Endoscopic approach

  • 29848 – Endoscopic carpal tunnel release

Pain and swelling could occur after the procedure. Splints may be recommended after surgery to improve the outcome. Documenting Carpal Tunnel Syndrome for medical claims requires excellent knowledge of the updates in medical coding and insurance policies. Orthopedic medical billing services provided by an experienced medical billing and coding company can help physicians with timely claims processing and collections that are important for proper revenue management.

Documenting Neuroendocrine Tumors – An Overview of the ICD-10 Codes

Neuroendocrine tumors (NET) are abnormal growths that begin in specialized cells called neuroendocrine cells. Neuroendocrine cells have traits similar to nerve cells and hormone-producing cells. These cells can occur anywhere in the body, but NETs are most often found in the lungs, appendix, abdomen, small intestine, adrenal glands, rectum and pancreas. Neuroendocrine tumors can be noncancerous (benign) or cancerous (malignant). The condition is rare, complex and may be difficult to diagnose. Diagnosis and treatment options for this condition depend on many factors such as the tumor’s type, location, aggressiveness, and hormone-producing capabilities; as well as whether it has metastasized. If left untreated, this condition can spread to other parts of the body and cause severe complications. Management options may include careful surveillance, surgery to remove the tumor and/or surrounding tissue, and various non-surgical therapies to shrink the tumor, or stop it from growing. Oncologists or other specialists treating this condition can rely on reputable medical billing companies to meet their claim submission tasks and thus receive correct reimbursement on time.

Reports suggest that the total incidence of neuroendocrine tumors is between five and nine million people in the United States. It is possible that these tumors are underreported because they grow slowly and do not always produce dramatic symptoms. Many of the symptoms of tumor are due to the hormones that the tumor secretes and these hormones can affect the whole body.

Types of Neuroendocrine Tumors (NET) and Symptoms

There are different types of neuroendocrine tumors, the most common types include –

  • Carcinoid tumors – These are tumors that most commonly arise in the digestive tract, lungs, appendix or thymus. In addition, they can also grow in the lymph nodes, brain, bone, gonads (ovaries and testes) or skin.
  • Pancreatic neuroendocrine tumors (also called islet cell tumors) – This type of tumor typically arises in the pancreas, although they can also occur outside the pancreas.
  • Pheochromocytoma – This is a rare type of NET that typically develops in the adrenal gland, but can also arise in other parts of the body.

People with neuroendocrine tumors do not experience any specific symptoms. Or else the cause of a symptom may be another medical condition that is not cancer. Common symptoms of NETs include –

  • Vomiting
  • Sweating
  • Rapid pulse
  • Nausea
  • High blood pressure
  • Headache
  • Fever
  • Clammy skin
  • Anxiety attacks
  • Heart palpitations
  • Painless, firm, shiny lumps on the skin that can be red, pink or blue
  • Persistent pain in a specific area
  • Loss of appetite or weight loss
  • A cough or hoarseness that does not go away
  • Thickening or lump in any part of the body
  • Changes in bowel or bladder habits
  • Unexplained weight gain or loss
  • Persistent fever or night sweats
  • High/low level of glucose in the blood

Diagnosing and Treating Neuroendocrine Tumors (NETs)

Making a correct diagnosis of this condition is often challenging. Initial diagnosis of this condition my generally begin with a detailed physical examination and evaluation of previous medical history and symptoms. Physicians may also consider conducting certain diagnostic tests to evaluate the condition correctly. The type of diagnostic tests to be conducted may depend on several factors – type of tumor, signs and symptoms, results of earlier medical tests and patient age and medical condition.

Regular and standard screening tests help to detect the condition in its earliest stages and provide the greatest chance of cure. A wide range of screening tests like X-ray, Magnetic resonance imaging (MRI), Computed tomography (CT or CAT) scan, Positron emission tomography (PET) or PET-CT scan, molecular testing of the tumor and biopsy will help detect the disease early. In addition, physicians may collect blood and urine samples to check for abnormal levels of hormones and other substances.

The type of treatment modality to be opted for this condition may depend on several factors like – the type of neuroendocrine tumor, whether the tumor is cancerous and if so the stage of cancer, possible side effects and the patient’s preferences and overall health. Top treatment options include – alpha-adrenergic blockers, chemotherapy and radiation therapy. Laproscopic surgery to remove the tumor will also be performed.

Oncology medical billing and coding can be challenging. The diagnosis, screening tests and other procedures must be carefully documented using appropriate medical codes. Medical billing services offered by reputable service providers can help physicians use the right ICD-10 codes for their medical billing process.

ICD – 10 Codes for NETs

C7A – Malignant neuroendocrine tumors

  • C7A.0 – Malignant carcinoid tumors
    • C7A.00 – Malignant carcinoid tumor of unspecified site
  • C7A.01 – Malignant carcinoid tumors of the small intestine
    • C7A.010 – Malignant carcinoid tumor of the duodenum
    • C7A.011 – Malignant carcinoid tumor of the jejunum
    • C7A.012 – Malignant carcinoid tumor of the ileum
    • C7A.019 – Malignant carcinoid tumor of the small intestine, unspecified portion
  • C7A.02 – Malignant carcinoid tumors of the appendix, large intestine, and rectum
    • C7A.020 – Malignant carcinoid tumor of the appendix
    • C7A.021 – Malignant carcinoid tumor of the cecum
    • C7A.022 – Malignant carcinoid tumor of the ascending colon
    • C7A.023 – Malignant carcinoid tumor of the transverse colon
    • C7A.024 – Malignant carcinoid tumor of the descending colon
    • C7A.025 – Malignant carcinoid tumor of the sigmoid colon
    • C7A.026 – Malignant carcinoid tumor of the rectum
    • C7A.029 – Malignant carcinoid tumor of the large intestine, unspecified portion
  • C7A.09 – Malignant carcinoid tumors of other sites
    • C7A.090 – Malignant carcinoid tumor of the bronchus and lung
    • C7A.091 – Malignant carcinoid tumor of the thymus
    • C7A.092 – Malignant carcinoid tumor of the stomach
    • C7A.093 – Malignant carcinoid tumor of the kidney
    • C7A.094 – Malignant carcinoid tumor of the foregut, unspecified
    • C7A.095 – Malignant carcinoid tumor of the midgut, unspecified
    • C7A.096 – Malignant carcinoid tumor of the hindgut, unspecified
    • C7A.098 – Malignant carcinoid tumors of other sites
  • C7A.1 – Malignant poorly differentiated neuroendocrine tumors
  • C7A.8 – Other malignant neuroendocrine tumors

The symptoms of neuroendocrine tumors are wide-ranging, depending on the specific location in the body where the disease is found. A correct combination of adequate supportive care therapies may help you manage the side effects of the disease in a better manner.

Medical billing and coding for neuroendocrine tumors (NETs) can be complex, as there are several codes associated with the condition. By outsourcing medical billing and coding tasks to a reliable medical coding company (that offers the services of AAPC-certified coding specialists), healthcare practices can ensure correct and timely medical billing and claims submission.

Documenting Hemarthrosis with the Correct ICD-10 Codes

Hemarthrosis is a condition that occurs as a result of bleeding into a joint cavity. Blood vessels inside the joint are damaged and bleed. The blood then collects in the joint space. Joints, also called articulations, are the connections between two bones that allow movement. Also known as articular bleeding, the joint condition can begin after a joint injury or it may develop spontaneously if you are prone to bleeding. Common causes include trauma or injury (like a sprain, fracture, or torn ligament), a bleeding disorder such as hemophilia, use of medications to prevent blood clots (blood thinners) such as warfarin, infections, osteoarthritis, neoplasms and arthroscopic surgery. The condition causes pain and swelling of the joint. If left untreated, hemarthrosis can inflame and thin the cartilage, causing pain, weakness, swelling, or additional bleeding into the joint resulting in permanent changes in joint structure and function. Medical specialists treating this condition can rely on reputable medical billing companies to meet their claim submission tasks and thus receive reimbursement on time.

A joint that has recurring hemarthrosis (bleeding episodes) is known as a target joint – which means or requires that around four separate bleeds must have occurred in the same joint within a six-month period. However, a target joint can also be caused by one severe bleed. The most common joints affected are the knees, ankles and elbows. In addition, it can also occur in the hip, shoulders and wrists.

Identify the Symptoms

Most people experience signs and symptoms of this condition much later in their life – usually between the ages of 50 and 60. Women are more likely to develop symptoms after menopause, when they no longer lose iron with menstruation and pregnancy. The signs and symptoms associated with the condition can range from mild to severe, and are generally worse if there is a large amount of bleeding. Common symptoms include –

  • Tingling, aching, or bubbling sensation at the joint
  • Pain or tenderness and swelling
  • Joint redness and warmth
  • Trouble moving the joint or joint stiffness
  • Excessive bruising near the affected joint
  • Decrease in range of motion (the joint can’t be fully extended or flexed)
  • Red skin over the affected joint

The continuous bleeding can significantly damage the joint. In most cases, one severe bleed or a series of smaller bleeds can cause permanent damage. Eventually, the soft tissues, ligaments and tendons surrounding the joint shrink and lead to reduced range of motion in the joint.

How Is Articular Bleeding Diagnosed and Treated?

Diagnosis of articular bleeding will generally begin with a detailed evaluation of previous medical history. Physicians will begin the evaluation by asking questions about any specific joint condition and recent injuries the patient suffered and the medications consumed. Patients must communicate to their physician if they have a family history of a bleeding disorder.

Physicians will ask questions about the symptoms and conduct a detailed physical examination. They may move or bend the specific joint (where the patient experiences symptoms) in order to test its range of motion. A wide range of diagnostic tests such as blood tests (to measure the amount of clotting factor present) and imaging tests like X-rays and MRI will be conducted. In some cases, synovial fluid analysis will be done to diagnose the cause of joint inflammation. In this procedure, a needle will be inserted into the joint to draw fluid into a syringe (also called joint aspiration). Reddish-colored fluid could mean blood is present. The sample is then sent to a laboratory for further testing.

Treatment for hemarthrosis depends on the cause and may include simple at-home remedies, medication for pain relief and swelling, removal of the blood, and/or to prevent bleeding. The type of treatment depends on the underlying cause of the joint damage and the severity of the damage. Treatment options may generally include resting and icing the joint, elevating the affected limb, draining the blood from the joint and consuming pain medications such as Advil (ibuprofen) and Aleve (naproxen). Surgery to clean out or replace the joint will be considered as a last resort. There are two main types of surgery for treating hemarthrosis. The first one is synovectomy involving removal of the synovium, which is the lining of a joint. The secondary surgical option is joint replacement in which a surgeon completely removes the damaged joint and bone and replaces it with plastic and metal components. As an alternative to surgery, or after surgery for hemarthrosis, a person will need to undergo physical therapy – which will help in early recovery and prevent further joint deformities.

Orthopedics medical billing and coding can be challenging as it involves using several code categories. Physicians or spinal specialists who treat hemarthrosis must use the relevant ICD-10 codes to bill for the procedure. The medical codes used to report hemarthrosis include –

M25.0 – Hemarthrosis

  • M25.00 – Hemarthrosis, unspecified joint

M25.01 – Hemarthrosis, shoulder

  • M25.011 – Hemarthrosis, right shoulder
  • M25.012 – Hemarthrosis, left shoulder
  • M25.019 – Hemarthrosis, unspecified shoulder

M25.02 – Hemarthrosis, elbow

  • M25.021 – Hemarthrosis, right elbow
  • M25.022 – Hemarthrosis, left elbow
  • M25.029 – Hemarthrosis, unspecified elbow

M25.03 – Hemarthrosis, wrist

  • M25.031 – Hemarthrosis, right wrist
  • M25.032 – Hemarthrosis, left wrist
  • M25.039 – Hemarthrosis, unspecified wrist

M25.04 – Hemarthrosis, hand

  • M25.041 – Hemarthrosis, right hand
  • M25.042 – Hemarthrosis, left hand
  • M25.049 – Hemarthrosis, unspecified hand

M25.05 – Hemarthrosis, hip

  • M25.051 – Hemarthrosis, right hip
  • M25.052 – Hemarthrosis, left hip
  • M25.059 – Hemarthrosis, unspecified hip

M25.06 – Hemarthrosis, knee

  • M25.061 – Hemarthrosis, right knee
  • M25.062 – Hemarthrosis, left knee
  • M25.069 – Hemarthrosis, unspecified knee

M25.07 – Hemarthrosis, ankle and foot

  • M25.071 – Hemarthrosis, right ankle
  • M25.072 – Hemarthrosis, left ankle
  • M25.073 – Hemarthrosis, unspecified ankle
  • M25.074 – Hemarthrosis, right foot
  • M25.075 – Hemarthrosis, left foot
  • M25.076 – Hemarthrosis, unspecified foot

Hemarthrosis is not a common condition, but it is important to know about the symptoms and other complications associated with the condition. Mild to moderate joint bleeding can resolve with time. However, patients having swelling of one or more joints in their body should immediately consult a pain management physician. Treatment can alleviate the pain, discomfort, and swelling and prevent long-term complications and joint damage. People who experience bleeding on a regular basis, or have a severe bleed that is not treated right away, can sustain permanent damage to the joint.

Knowing the highly specific ICD-10 codes related to documenting joint damages is critical for providers. Partnering with an experienced medical billing and coding company is important for physicians to ensure accurate and timely claim submissions.

How to Document and Code for Hypertension Using ICD-10 Codes

Hypertension (HTN), also known as high blood pressure (HBP) is a common condition in which the blood pressure in the arteries is constantly elevated. Generally, blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. The long-term force of the blood against your artery walls is high enough to cause severe health complications like heart disease, stroke or even death. The medical guidelines issued by the American Heart Association (AHA) 2017 define hypertension as blood pressure that is higher than 130 over 80 millimeters of mercury (mmHg). Without early diagnosis and proper treatment, HBP can lead to life-threatening conditions. Physicians treating this condition can depend on reliable medical billing companies for accurate and timely claim filing for appropriate reimbursement.

Reports from the American Heart Association (AHA, 2018 statistics) say that an estimated 103 million U.S. adults have high blood pressure – which is nearly half of all adults in the United States. Acute causes of high blood pressure include stress, but it can happen on its own or from an underlying condition, like kidney disease. In most cases, people with HBP don’t experience any specific signs or symptoms, even if blood pressure readings reach dangerously high levels. On the other hand, some people may experience minor symptoms like headache, shortness of breath or nosebleeds. Often, these signs and symptoms aren’t specific and don’t occur until blood pressure has reached a severe or life-threatening stage. Potential risk factors that may increase the chances of having hypertension include – age, family history, increased body weight, alcohol and tobacco use, physical inactivity, a salt-rich diet (involving processed and fatty foods) and presence of certain health conditions like cardiovascular disease, diabetes, chronic kidney disease and high cholesterol levels.

Types of Hypertension (HTN)

Hypertension can be Primary (essential) hypertension and secondary hypertension. These two types of hypertension account for about 90% of all hypertension cases. For primary/essential hypertension – there is no identifiable cause of high blood pressure and the condition tends to develop gradually over many years. Caused by an underlying condition, secondary hypertension tends to appear suddenly and cause higher blood pressure than the primary type. Diseases that might be a cause of hypertension include – chronic kidney disease, sleep apnea, adrenal gland tumors, alcohol addiction, thyroid dysfunction, congenital defects and use of certain medication. In this type of hypertension, once the root cause is treated, blood pressure usually returns to normal or is significantly lowered.

However, there are several types of HTN that are less common, but are not less important. These include – malignant hypertension, resistant hypertension, pulmonary hypertension, isolated systolic hypertension, Pseudo-hypertension and White coat hypertension. This means it is important to know how to monitor hypertension based on its type.

How to Diagnose and Treat HTN?

As part of initial diagnosis, physicians will conduct a detailed physical examination and review the patient’s previous medical history. The blood pressure is measured using a pressure-measuring gauge. Blood pressure readings, given in millimeters of mercury (mm Hg), have two numbers. The first, or upper, number measures the pressure in the arteries when the heart beats (systolic pressure). The second, or lower, number measures the pressure in the arteries between beats (diastolic pressure). Blood pressure measurements fall into four general categories –

  • Normal blood pressure – if it’s below 120/80 mm Hg
  • Elevated blood pressure – if it’s a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below 80 mm Hg
  • Stage 1 hypertension – if it’s a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.
  • Stage 2 hypertension – if it’s a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher

Both numbers in a blood pressure reading are important. However after 50 years of age, the systolic reading is even more significant. Physicians will generally take 2-3 readings each at three or separate appointments before making a final diagnosis. This is because blood pressure normally varies throughout the day, and it may be elevated during visits to the doctor.

Physicians may recommend a 24-hour blood pressure monitoring test called “ambulatory blood pressure monitoring” which measures the blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of blood pressure changes over an average day and night. In addition, physicians may also recommend other routine tests like – urine test (urinalysis), blood tests, cholesterol test, electrocardiogram (that measures the heart’s electrical activity) and echocardiogram to check for more signs of heart disease.

Treatment for this condition involves a combination of medications and changes in lifestyle habits. Medications include – Angiotensin-converting enzyme (ACE) inhibitors, Calcium channel blockers, Alpha-beta blockers and Renin inhibitors. Incorporating key lifestyle changes like eating a heart-healthy diet (with less salt and fatty foods), limiting the amount of alcohol, doing regular physical activity and maintaining a healthy body weight can help reduce blood pressure.

Medicare Coverage and Coding Guidelines

If you are diagnosed with high blood pressure, Medicare Part B covers all medically necessary doctor visits and outpatient tests and procedures to treat and manage your condition. Medicare Part B may also pay for weight loss counseling sessions and smoking cessation sessions if performed by a qualified professional who accepts Medicare assignment.

Cardiology medical billing and coding is challenging, as it involves numerous rules related to reporting the procedure accurately. Cardiologists or other specialists who treat hypertension and other associated conditions must use the relevant ICD-10 codes to bill for the procedure.

The ICD-10 codes for diagnosing hypertension and other related conditions include –

I10 – Primary (essential) hypertension

I15 – Secondary hypertension

  • I15.0 – Renovascular hypertension
  • I15.1 – Hypertension secondary to other renal disorders
  • I15.2 – Hypertension secondary to endocrine disorders
  • I15.8 – Other secondary hypertension
  • I15.9 – Secondary hypertension, unspecified

Hypertension and Associated Conditions

If a patient with hypertension is confirmed to have co-morbid heart and/or kidney disease, it should be reported using ICD-10 codes in the following manner –

Hypertension and Heart Disease

I11 – Hypertensive heart disease

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

Hypertension and Chronic Kidney Disease

If the patient has hypertension and then develops chronic kidney disease, ICD-10 will consider that condition as hypertensive chronic kidney disease. However, if the chronic kidney disease occurs first and then the combination, their codes fall under the secondary hypertension codes.

I12 – Hypertensive chronic kidney disease

  • 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

Both these codes require an additional N18 code to specify the stage of kidney disease.

  • N18.1 – Chronic kidney disease, stage 1
  • N18.2 – Chronic kidney disease, stage 2 (mild)
  • N18.3 – Chronic kidney disease, stage 3 (moderate)
  • N18.4 – Chronic kidney disease, stage 4 (severe)
  • N18.5 – Chronic kidney disease, stage 5
  • N18.6 – End-stage renal disease
  • N18.9 – Chronic kidney disease, unspecified

Hypertension, Heart Disease and Chronic Kidney Disease

The ICD-10 codes for the three-disease combination (if the patient has all the three conditions, hypertension, heart disease and chronic kidney disease) are classified according to the degree of chronic kidney disease rather than the presence or absence of heart failure.

I13 – Hypertensive heart and chronic kidney disease

  • 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
  • I13.1 – Hypertensive heart and chronic kidney disease without heart failure
    • 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

Just as the two-disease combination codes, the above codes also require additional codes from the N18 series to specify the stage of kidney disease.

Coding for Nicotine Dependence

An additional ICD-10 code is required for all hypertension codes if the patient uses tobacco currently or had used it earlier. The codes for nicotine use include –

F17 – Nicotine dependence

  • F17.2 – Nicotine dependence
    • F17.20 – Nicotine dependence, unspecified
    • F17.21 – Nicotine dependence, cigarettes
    • F17.22 – Nicotine dependence, chewing tobacco
    • F17.29 – Nicotine dependence, other tobacco product

Other Hypertension Codes

I27.0 – Primary pulmonary hypertension
I27.2 – Other secondary pulmonary hypertension

  • I27.20 – Pulmonary hypertension, unspecified
  • I27.21 – Secondary pulmonary arterial hypertension
  • I27.22 – Pulmonary hypertension due to left heart disease
  • I27.23 – Pulmonary hypertension due to lung diseases and hypoxia
  • I27.24 – Chronic thromboembolic pulmonary hypertension
  • I27.29 – Other secondary pulmonary hypertension

High blood pressure (HBP) generally develops over many years, and can affect nearly everyone. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage. Uncontrolled high blood pressure can lead to complications including heart attack or stroke, aneurysm, dementia, trouble with memory and metabolic syndrome. However, a right combination of medications along with significant lifestyle changes can help people effectively control and prevent blood pressure in the long run.

Medical coding for hypertensive disorders can be complex, as there are several categories of codes. Outsourcing medical billing tasks to a reliable and established medical billing and coding company (that provides the services of AAPC-certified coding specialists) can help with correct and timely claims submissions.

Coding Aortic Valve Stenosis– Be Familiar with the Related Medical Codes

Regarded as one of the most common and serious valve disorders, Aortic valve stenosis (also called aortic stenosis) occurs when the heart’s aortic valve narrows. The aortic valve – a key valve in the body’s blood circulation system – opens to allow blood to flow into the aorta – the main artery that carries blood out of the heart to the body. If you have aortic stenosis, this valve does not open fully and this abnormal narrowing makes it extremely difficult for blood to flow from the heart to the body and onward to the rest of your body. When the blood flow through the aortic valve is reduced or blocked, the heart needs to work harder to pump blood to the body, which can possibly weaken the heart muscles. Treatment for this heart condition depends on the severity of symptoms and may generally include surgery to repair or replace the valve. If left untreated, this condition can lead to serious heart complications. Medical billing and coding for aortic stenosis can be challenging for healthcare providers. Outsourcing to a reliable medical billing and coding company can help in timely claim submission and correct reimbursement.

As per 2018 reports, about 2.5 million people in the United States (over the age of 75 years) suffer from aortic valve stenosis – which is about 12.4 percent of the total population. It is estimated that this figure will increase at a high pace by the end of 2050. Aortic valve stenosis can occur due to several causes like – congenital heart defect, rheumatic fever and calcium buildup on the valves. Early diagnosis and timely treatment can help prevent the incidence of complications like – heart failure, stroke, blood clots, heart rhythm abnormalities (arrhythmias) and even death.

Does Aortic Stenosis Always Produce Symptoms?

Many people with aortic stenosis do not experience noticeable symptoms until the amount of restricted blood flow becomes significantly reduced. In most cases, the signs and symptoms develop when narrowing of the valve is severe. Signs and symptoms of this heart valve disorder may include –

  • Breathlessness
  • Chest pain (angina), pressure or tightness
  • Feeling faint or dizzy or fainting with activity
  • Palpitations or a feeling of heavy, pounding, or noticeable heartbeats
  • Decline in activity level or reduced ability to do normal activities requiring mild exertion
  • Heart murmur
  • Fatigue, especially during times of increased activity

Potential risk factors associated with the condition include – age, history of heart infections, chronic kidney disease, history of radiation therapy to the chest and cardiovascular risk factors such as diabetes, high cholesterol and high blood pressure.

Understanding the Treatment Options

Several diagnostic imaging tests like – echocardiogram, electrocardiogram (ECG), cardiac computerized tomography (CT) scan, chest X-ray, cardiac MRI and cardiac catheterization may be ordered to determine the cause and severity of the condition.

Surgery to repair or replace an aortic valve is the major treatment option for this condition. Surgery options include – aortic valve repair, balloon valvuloplasty and aortic valve replacement. Cardiology medical coding involves using the relevant CPT codes as well as the ICD-10 codes on the medical claims submitted to health insurers for reimbursement.

CPT Codes

  • 33361 – Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach
  • 33362 – Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach
  • 33363 – Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach
  • 33364 – Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach
  • 33365 – Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach
  • 33366 – Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure
  • 33367 – Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation
  • 33368 – Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation
  • 33369 – Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation

ICD-10 Codes

  • I35 – Nonrheumatic aortic valve disorders
    • I35.0 – Nonrheumatic aortic (valve) stenosis
    • I35.1 – Nonrheumatic aortic (valve) insufficiency
    • I35.2 – Nonrheumatic aortic (valve) stenosis with insufficiency
    • I35.8 – Other nonrheumatic aortic valve disorders
    • I35.9 – Nonrheumatic aortic valve disorder, unspecified

Preventing this heart valve disorder involves incorporating several heart-healthy lifestyle changes into the patient’s life including – consuming a healthy and nutritious diet, maintaining a healthy body weight, getting regular physical activity, avoiding tobacco and managing stress. Women with aortic valve stenosis should consult their physician before becoming pregnant. Treating and managing patients with aortic stenosis can be quite challenging for cardiologists or other physicians. Outsourcing medical billing and coding tasks is a practical option for physicians to ensure appropriate care for their patients as well as accurate clinical documentation of the heart valve-disorder.