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ICD-10-CM Coding for Hypertensive Heart Disease and Related Conditions

by | Aug 18, 2016 | Medical Coding News, Resources | 0 comments

Hypertensive heart disease, the main cause of death associated with hypertension or high blood pressure, refers to heart failure, coronary artery disease, and enlargement of the heart. Compared to the ICD-9-CM code for hypertensive heart disease (402.90), ICD-10-CM allows physicians to report this condition as well as other related conditions such as chronic kidney disease and hypertension, more accurately.

Essential (primary) hypertension and hypertensive heart disease

In ICD-10 coding, there is only one code for primary hypertension: I10. However, there are specific codes to describe hypertensive cardiovascular disease, without and with heart failure.

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

To assign a code from category I11, hypertensive heart disease, documentation must state (heart failure due to hypertension) or imply a causal relationship (hypertensive heart failure). Moreover, in the case of I11.0, an additional code is needed to indicate the type of heart failure. For instance:

  • I50.1, Left ventricular failure
  • I50.2X, Systolic (congestive) heart failure

Hypertensive chronic kidney disease

A code from category I12, hypertensive chronic kidney disease, will be required to code a patient diagnosed with both hypertension and chronic kidney disease.Examples:

  • 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

In both these cases, additional codes will be required to indicate the stage of the kidney disease, such as:

  • N18.1, Chronic kidney disease, stage 1
  • N18.4, Chronic kidney disease, stage 4 (severe)
  • N18.5, Chronic kidney disease, stage 5

Hypertensive heart disease and chronic kidney disease

If a patient is diagnosed with both hypertensive heart disease and chronic kidney disease, a code from the I13 category should be used. The code will indicate whether the patient has heart failure or not, and the stage of the chronic kidney disease. For instance:

I13.0, Hypertensive heart and chronic kidney disease with heart failure and with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease.

Additional codes should be used to indicate the type of heart failure and the stage of the kidney disease.

In a scenario where payment for healthcare services depends on utilization, quality, and outcomes, such specificity is crucial.

Physicians are responsible for ensuring proper documentation. Accurately communicating the patient’s condition to the payer is important for group practices in accountable care organizations and those with risk-adjusted commercial payer contracts. Relying on professional medical coding services is a great option to tackle the complexities of ICD-10 coding. Established medical coding companies provide end-to-end solutions to help physicians manage claims processing and maximize revenue cycle efficiency.