Because ICD-10 have the right to be a distressing topic, let"s start with some an excellent news: Hypertension has a minimal number that ICD-10 codes – only nine password for main hypertension and also five codes for an additional hypertension. This makes the task of coding hypertension reasonably simple – well, in ~ least compared to several of the various other ICD-10 complexities.
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Another positive change in ICD-10 is the the new code collection drops the previous referral to benign and also malignant hypertension. Together physicians, we are well mindful that hypertension is never truly “benign,” and also the removed of this antiquated term is a welcome innovation in the lexicon that diseases.
But, the course, nothing is simple in ICD-10, and there are numerous things you should be aware of prior to we dig right into the password themselves. Because that example, the hypertensive condition codes in ICD-10 exclude numerous conditions: hypertension complicating pregnancy, neonatal hypertension, major pulmonary hypertension, and primary and an additional hypertension including vessels of the brain or the eye. Postprocedural hypertension is also excluded from the second hypertension codes.
In addition, you"ll need to be cautious throughout the “Diseases of the Circulatory System” chapter of ICD-10 to distinguish the funding “I” from the number “1.” The hypertension codes span from I10 to I15 (there is no I14), and also each collection has its very own peculiarities, as this write-up will explain.
This post contains number of code lists and tables, which are obtainable here because that download together a single resource.
In ICD-9, crucial hypertension was coded using 401.0 (malignant), 401.1 (benign), or 401.9 (unspecified). ICD-10 provides only a solitary code for individuals who accomplish criteria because that hypertension and do not have actually comorbid love or kidney disease. That code is I10, necessary (primary) hypertension.
As in ICD-9, this code has “high blood pressure” however does not encompass elevated blood pressure without a diagnosis that hypertension (that would certainly be ICD-10 password R03.0). If a patient has developed from elevated blood press to a official diagnosis the hypertension, a good documentation practice would it is in to include the factor for advancing the official diagnosis. Similarly, a single mildly elevated blood pressure reading should be coded with the R03.0 until the official diagnosis is established.
Although assorted sources define hypertension slightly differently, the provider should record elevated systolic pressure over 140 or diastolic pressure above 90 through at the very least two readings on separate office visits. There are slight sport of this because that older individuals and also for individuals with readings acquired through ambulatory blood pressure monitoring. Native a documentation viewpoint, it is only necessary that the provider plainly document the basis because that a newly developed diagnosis.
Example: your patient, a 55-year-old female, has had blood push readings in between 130–135/80–85 for numerous years. In ~ her yearly examination, you document her blood pressure as 144/92 and 142/90. You comment on with she the prominence of following up and also schedule an additional appointment for 2 weeks later. At that time, she again has several readings above 140/90, so you paper the progression from prehypertension (R03.0) to crucial hypertension (I10).
When an individual has actually hypertension and heart disease, that is approximately the provider to determine whether there is a causal relationship proclaimed or implied. This partnership determination is spelled out in the “Official Guidelines because that Coding and Reporting” (draft 2014).1
The combination of hypertension and also hypertensive heart disease is at this time coded making use of the ICD-9 402.xx collection of codes. As noted earlier, each category is right now divided into malignant, benign, and unspecified essential hypertension with or without love failure. In ICD-10, this is small to just two basic codes:I11.0, Hypertensive heart an illness with heart failure,
I11.9, Hypertensive heart condition without heart failure.
The ICD-10 hand-operated does not list the compelled documentation for hypertensive heart disease. It is recommended, however, that the provider record the basis because that the diagnosis (exam, electrocardiogram, echocardiogram, etc.) at least the an initial time this diagnosis is produced the patient. The is not unusual for patients through long-standing hypertension to build some cardiac changes, but to code I11.9 rather of simply I10, the provider requirements to record the assistance for doing so.
Unlike ICD-9, when you password hypertension v heart failure (I11.0) making use of ICD-10, girlfriend are compelled to also code the form of heart failure from the I50 series:I50.1, Left ventricular failure,
I50.2, Systolic (congestive) love failure,
I50.3, Diastolic (congestive) heart failure,
I50.4, linked systolic and also diastolic love failure,
I50.9, love failure, unspecified.
If you carry out not have a measure up of the left ventricular ejection portion (typically native an echocardiogram), climate you would have to use the an ext general left ventricular failure code (I50.1).
The three codes because that systolic, diastolic, and combined failure likewise require a 5th digit specifying the acuity of the diagnosis:0, Unspecified,
3, Acute top top chronic.
Example: You have been complying with a 60-year-old male v hypertension and mild heart failure. You have actually coded I11.0 and also I50.9. That recently had actually an acute exacerbation the his heart failure, was briefly hospitalized, and also had an echocardiogram perform documenting combined systolic and also diastolic failure. In ~ discharge, you update his diagnosis password to I11.0 and also I50.43. Once you watch him in the office 2 weeks post-discharge and also he is asymptomatic, his diagnosis codes might be I11.0 and I50.42 mirroring the chronic nature that his condition.
Unlike hypertension and also heart disease, where the provider must determine whether a causal partnership exists, if the patient has hypertension and develops chronic kidney disease, ICD-10 presumes a cause and effect relationship and classifies the problem as hypertensive chronic kidney disease. Note, however, the if the chronic kidney condition came first, climate the combination falls right into the an additional hypertension codes questioned later in this article.
Both ICD-9 and also ICD-10 require specifying the stage of the chronic kidney condition to effectively code the condition. Very couple of patients have actually a true glomerular filtration price (GFR) measured and most staging depends on the estimated glomerular filtration rate (eGFR). Most laboratory reports provide a race-based recommendation range. That is not uncommon for these approximates to have slight variability and for the patient"s staging to vary between stage 2 and also 3. Note that ICD-10 differentiates phase 5 indigenous end-stage renal disease by the need for chronic dialysis.
ICD-10 requires an initial using one I12 code for the combined diagnosis of hypertension and chronic kidney disease:I12.0, Hypertensive chronic kidney disease with phase 5 chronic kidney an illness or end-stage renal disease,
I12.9, Hypertensive chronic kidney an illness with phase 1 with 4 chronic kidney condition or unspecified chronic kidney disease.
These two codes require second N18 password to determine the phase of kidney disease, with documentation commonly referencing the most recent eGFR:N18.1, Chronic kidney disease, phase 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, phase 5,
N18.6, End-stage renal disease,
N18.9, Chronic kidney disease, unspecified.
Example: You have been dealing with a 55-yearold black female for hypertension (I10) because that the past 5 years. Top top her most recent office visit, friend performed a considerable metabolic profile. All values were within the laboratory reference range except her BUN and creatinine. The activities calculated her eGFR in ~ 40 (mL/min/1.73m2). Repeat testing produces a similar result. You update her diagnosis codes to I12.9 and N18.3.
To confuse problem further, if the patient has actually all three conditions (hypertension, love disease, and also chronic kidney disease), climate you require to paper the relationship in between the hypertension and also heart condition but assume the causal relationship in between hypertension and chronic kidney disease. The documentation needs are the very same as what was outlined above.
The codes for the three-disease mix are numerically i ordered it by the degree of chronic kidney disease rather 보다 the presence or lack of heart failure:I13.0, Hypertensive heart and also chronic kidney condition with love failure and with phase 1 with 4 chronic kidney disease, or unspecified chronic kidney disease,
I13.10, Hypertensive heart and chronic kidney disease without heart failure with phase 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease,
I13.11, Hypertensive heart and also chronic kidney condition without heart fail with phase 5 chronic kidney disease, or end-stage renal disease,
I13.2, Hypertensive heart and also chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end-stage renal disease.
As through the two-combination codes, all of the three-combination codes require extr coding native the N18 series to recognize the stage of kidney disease. The three-combination password that include heart failure also require additional coding indigenous the I50 series to clues the kind and acuity of the failure.
Example: The 55-year-old mrs in the above example presents to her office through some pedal edema, and also on check you likewise detect some mild crackles in the basic of she lungs. Friend order one echocardiogram that documents mild systolic heart failure. She eGFR has remained stable. You update her diagnostic password to I13.0 (Hypertensive heart and also chronic kidney an illness with love failure and with stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease), I50.21 (Systolic, congestive, heart failure, acute), and also N18.3 (Chronic kidney disease, phase 3, moderate).
All the the hypertension codes require secondary ICD-10 password if the patient is a current or former tobacco user. In most cases, you would certainly use among the complying with codes uncovered in chapter 5, “Mental, Behavioral, and Neurodevelopmental Disorders”:F17, Nicotine dependence,
F17.22, Chewing tobacco,
F17.29, various other tobacco product.
Each the these 4 categories has a compelled sixth character:0, uncomplicated,
1, in remission,
3, v withdrawal,
8, with various other specified nicotine-induced disorder,
9, through unspecified nicotine-induced disorder.
If you have not documented that a patience who supplies tobacco is “dependent,” then you would instead use the code for tobacco usage (Z72.0). The difference is not well-defined, but the Centers for an illness Control and Prevention"s website states, “Tobacco use deserve to lead to tobacco/nicotine dependence and also serious health troubles … Tobacco/nicotine dependence is a chronic problem that regularly requires repeated interventions.”
Occupational and also environmental exposure come tobacco should likewise be coded if the provider believes these are affecting the patient"s wellness status. The codes room as follows:Z57.31, work-related exposure to ecological tobacco smoke,
Z72.0, difficulties related come lifestyle, tobacco use,
Z77.22, Exposure to environmental tobacco exhilaration (includes second-hand acting exposure and passive smoking),
Z87.891, Personal background of nicotine dependence.
The ICD-10 hand-operated partially defines the difference in between Z87.891, “Personal background of nicotine dependence,” and also F17.211, “Nicotine dependence, cigarettes, in remission.” It claims that a personal background code must be used if a patient"s problem no much longer exists and is not being treated yet has the potential come recur and, therefore, may require continuous monitoring. The remission code would certainly be appropriate if a patient is actively using a product to stop smoking. As soon as the patient has stopped utilizing such products, the is as much as the provider to recognize when the patient"s status would move from “in remission” to “personal background of.”
Although the main emphasis of this short article has been crucial hypertension, including comorbidities of love failure and also chronic kidney disease, there may be part patients in the main care setting who have hypertension secondary to other condition states. In these cases, providers cannot usage the hypertension ICD-10 codes disputed above. Instead, usage the following codes:I15.0, Renovascular hypertension,
I15.1, Hypertension secondary to various other renal disorders,
I15.2, Hypertension secondary to endocrine disorders,
I15.8, Other secondary hypertension,
I15.9, secondary hypertension, unspecified.
The five secondary hypertension codes need that you likewise code the underlying condition. ICD-10 typically permits one of two people the underlying problem or the secondary hypertension code to it is in listed an initial depending top top the reason for the patient encounter. The exception to this is I15.8, Other an additional hypertension. Due to the fact that this is an “other” code, the “other” problem must it is in coded first.
If this development to the brand-new hypertension codes has elevated your blood pressure, stop and take a deep breath. ICD-10 coding is a big adjustment, yet it will get much easier with time and practice. For an ext help, view the series overview and look because that future write-ups in FPM.
ARTICLES IN FPM"S ICD-10 SERIES
You can accessibility the following posts in FPM"s ICD-10 subject collection:
"ICD-10: major Differences because that Five typical Diagnoses," FPM, September/October 2015.
"ICD-10 Sprains, Strains, and also Automobile Accidents," FPM, May/June 2015.
"Digesting the ICD-10 GI Codes," FPM, January/February 2015.
"Coding typical Respiratory troubles in ICD-10," FPM, November/December 2014.
"ICD-10 Simplifies Preventive treatment Coding, sort Of," FPM, July/August 2014.
"ICD-10 Coding for the Undiagnosed Problem," FPM, May/June 2014.
"How to document and password for Hypertensive diseases in ICD-10," FPM, March/April 2014.
"10 procedures to Preparing your Office because that ICD-10 – Now," FPM, January/February 2014.
"Getting prepared for ICD-10: exactly how It Will affect Your Documentation," FPM, November/December 2013.
"The Anatomy of one ICD-10 Code," FPM, July/August 2012.
"ICD-10: What You require to know Now," FPM, March/April 2012.
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