ICD-10: Coding for Hypertension and Heart Disease

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 (ICD-9) to the tenth edition (ICD-10). 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 (benign hypertension) and 401.9 (hypertension, not otherwise specified) will be replaced by I10—essential (primary) hypertension.

But there are specific codes to describe hypertensive heart disease, hypertensive chronic kidney disease, and hypertensive heart and chronic kidney disease. If a physician determines that a patient has hypertension and heart disease caused by the hypertension, list first the combination code for hypertensive heart disease, either with or without heart failure. If the patient has heart failure, there is a notation to use an additional code from the I50 category to identify the type of heart failure.

A patient with hypertension and chronic kidney disease is coded with a code from category I12, hypertensive chronic kidney disease. I12.0 is for hypertensive chronic kidney disease in a patient with stage 5 or end-stage renal disease or 112.9 for hypertensive chronic kidney disease, stage 1 through stage 4.

Coding Options Increase

And of course, add another code to describe the stage of the chronic kidney disease. A coder may assume a causal relationship between hypertension and chronic kidney disease, but may not assume a causal relationship between hypertension and hypertensive heart disease.

If a patient has both hypertensive heart and chronic kidney disease, the coding options increase. Then, select a code from the I13 category. The code indicates whether the patient has heart failure or not, and the stage of the chronic kidney disease. As in the previous situations, use additional codes to identify the type of heart failure and the stage of the kidney disease.

Going through the extra trouble to select these more accurate codes doesn’t change the payment the medical practice receives for the current claim. But it does accurately communicate the acuity of the patient’s condition to the payer. This will make a difference for groups in accountable care organizations or with risk-adjusted commercial payer contracts.

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Photo courtesy of: Medscape

Originally published on: Medscape