How to Document and Code for Hypertensive Diseases in ICD-10

This installment in FPM'southward ICD-10 series explains the guidelines for coding hypertension.

Fam Pract Manag. 2014 Mar-April;21(2):5-ix.

Author disclosure: no relevant financial affiliations disclosed.

This content conforms to AAFP CME criteria. Come across FPM CME Quiz.

Article Sections

  • Introduction
  • Essential (primary) hypertension: I10
  • Hypertension and hypertensive middle disease: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive heart illness, and chronic kidney illness: I13
  • Tobacco use or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-10
  • References

Because ICD-10 can be a sad topic, let's showtime with some practiced news: Hypertension has a express number of ICD-10 codes – simply nine codes for primary hypertension and v codes for secondary hypertension. This makes the job of coding hypertension relatively elementary – well, at to the lowest degree compared to some of the other ICD-10 complexities.

Another positive change in ICD-10 is that the new code set drops the previous reference to benign and malignant hypertension. As physicians, we are well aware that hypertension is never truly "beneficial," and the removal of this antiquated term is a welcome improvement in the lexicon of diseases.

Just, of class, nothing is piece of cake in ICD-10, and at that place are several things you need to be aware of before nosotros dig into the codes themselves. For example, the hypertensive disease codes in ICD-10 exclude several conditions: hypertension complicating pregnancy, neonatal hypertension, primary pulmonary hypertension, and chief and secondary hypertension involving vessels of the brain or the center. Postprocedural hypertension is also excluded from the secondary hypertension codes.

In addition, you'll demand to exist conscientious throughout the "Diseases of the Circulatory System" chapter of ICD-x to differentiate the majuscule "I" from the number "1." The hypertension codes span from I10 to I15 (there is no I14), and each series has its own peculiarities, as this article will explain.

HYPERTENSIVE DISEASE ICD-10 CODES

This article contains several lawmaking lists and tables, which are available here for download as a single resource.

Download in PDF format

Essential (master) hypertension: I10

  • Abstract
  • Essential (principal) hypertension: I10
  • Hypertension and hypertensive heart affliction: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive heart disease, and chronic kidney disease: I13
  • Tobacco employ or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-10
  • References

In ICD-ix, essential hypertension was coded using 401.0 (malignant), 401.1 (benign), or 401.9 (unspecified). ICD-10 uses but a single lawmaking for individuals who come across criteria for hypertension and do non have comorbid heart or kidney disease. That code is I10, Essential (primary) hypertension.

As in ICD-nine, this lawmaking includes "loftier claret pressure" but does non include elevated blood pressure level without a diagnosis of hypertension (that would be ICD-10 lawmaking R03.0). If a patient has progressed from elevated claret pressure level to a formal diagnosis of hypertension, a good documentation practice would exist to include the reason for progressing the formal diagnosis. Similarly, a single mildly elevated claret pressure reading should be coded with the R03.0 until the formal diagnosis is established.

Although various sources define hypertension slightly differently, the provider should document elevated systolic pressure level above 140 or diastolic pressure level to a higher place xc with at to the lowest degree ii readings on divide office visits. There are slight variations of this for older individuals and for individuals with readings obtained through ambulatory blood pressure monitoring. From a documentation viewpoint, it is only of import that the provider conspicuously document the ground for a newly established diagnosis.

Instance: Your patient, a 55-year-old female, has had claret pressure readings between 130–135/lxxx–85 for several years. At her annual examination, y'all tape her blood pressure as 144/92 and 142/90. You discuss with her the importance of following up and schedule another appointment for two weeks later on. At that time, she again has several readings to a higher place 140/90, then y'all document the progression from prehypertension (R03.0) to essential hypertension (I10).

Hypertension and hypertensive center disease: I11

  • Abstract
  • Essential (chief) hypertension: I10
  • Hypertension and hypertensive heart affliction: I11
  • Hypertension and chronic kidney illness: I12
  • Hypertension, hypertensive heart disease, and chronic kidney disease: I13
  • Tobacco employ or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-10
  • References

When an individual has hypertension and heart illness, it is upwardly to the provider to determine whether there is a causal human relationship stated or unsaid. This relationship determination is spelled out in the "Official Guidelines for Coding and Reporting" (draft 2014).1

The combination of hypertension and hypertensive centre illness is currently coded using the ICD-9 402.xx serial of codes. Equally noted before, each category is currently divided into cancerous, benign, and unspecified essential hypertension with or without center failure. In ICD-10, this is narrowed to only two base of operations codes:

  • I11.0, Hypertensive heart disease with heart failure,

  • I11.nine, Hypertensive centre disease without eye failure.

The ICD-10 transmission does non list the required documentation for hypertensive eye illness. It is recommended, however, that the provider document the basis for the diagnosis (exam, electrocardiogram, echocardiogram, etc.) at least the first fourth dimension this diagnosis is made for the patient. It is not uncommon for patients with long-standing hypertension to develop some cardiac changes, but to code I11.9 instead of merely I10, the provider needs to document the back up for doing so.

Unlike ICD-9, when yous code hypertension with middle failure (I11.0) using ICD-x, you lot are required to also code the type of heart failure from the I50 serial:

  • I50.1, Left ventricular failure,

  • I50.2, Systolic (congestive) heart failure,

  • I50.three, Diastolic (congestive) center failure,

  • I50.iv, Combined systolic and diastolic center failure,

  • I50.9, Heart failure, unspecified.

If you do not have a measurement of the left ventricular ejection fraction (typically from an echocardiogram), then you lot would need to use the more than full general left ventricular failure lawmaking (I50.1).

The 3 codes for systolic, diastolic, and combined failure too require a fifth digit specifying the vigil of the diagnosis:

  • 0, Unspecified,

  • ane, Astute,

  • 2, Chronic,

  • iii, Astute on chronic.

Example: Yous have been following a sixty-year-old male with hypertension and balmy heart failure. You have coded I11.0 and I50.9. He recently had an acute exacerbation of his middle failure, was briefly hospitalized, and had an echocardiogram performed documenting combined systolic and diastolic failure. At discharge, you lot update his diagnosis codes to I11.0 and I50.43. When you come across him in the role ii weeks post-discharge and he is asymptomatic, his diagnosis codes could be I11.0 and I50.42 reflecting the chronic nature of his condition.

Hypertension and chronic kidney illness: I12

  • Abstruse
  • Essential (primary) hypertension: I10
  • Hypertension and hypertensive heart affliction: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive heart illness, and chronic kidney illness: I13
  • Tobacco use or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-ten
  • References

Unlike hypertension and middle disease, where the provider must decide whether a causal relationship exists, if the patient has hypertension and develops chronic kidney disease, ICD-10 presumes a cause and effect human relationship and classifies the condition as hypertensive chronic kidney disease. Note, however, that if the chronic kidney illness came first, then the combination falls into the secondary hypertension codes discussed later on in this article.

Both ICD-9 and ICD-10 require specifying the stage of the chronic kidney illness to properly code the condition. Very few patients have a true glomerular filtration rate (GFR) measured and about staging relies on the estimated glomerular filtration charge per unit (eGFR). Most laboratory reports provide a race-based reference range. It is non uncommon for these estimates to take slight variability and for the patient's staging to vary between stage 2 and 3. Annotation that ICD-10 differentiates phase 5 from terminate-stage renal disease past the need for chronic dialysis.

ICD-10 requires start using an I12 code for the combined diagnosis of hypertension and chronic kidney disease:

  • I12.0, Hypertensive chronic kidney illness with stage 5 chronic kidney affliction or end-stage renal disease,

  • I12.9, Hypertensive chronic kidney illness with stage 1 through 4 chronic kidney disease or unspecified chronic kidney illness.

These two codes require an boosted N18 code to identify the stage of kidney disease, with documentation typically referencing the most recent eGFR:

  • N18.one, Chronic kidney disease, stage ane,

  • N18.two, Chronic kidney illness, stage 2 (mild),

  • N18.3, Chronic kidney disease, stage three (moderate),

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

  • N18.5, Chronic kidney illness, phase 5,

  • N18.half dozen, Cease-stage renal disease,

  • N18.9, Chronic kidney disease, unspecified.

Example: You accept been treating a 55-yearold black female for hypertension (I10) for the past 5 years. On her most recent office visit, y'all performed a comprehensive metabolic profile. All values were within the laboratory reference range except her BUN and creatinine. The laboratory calculated her eGFR at 40 (mL/min/1.73m2). Repeat testing produces a similar issue. You lot update her diagnosis codes to I12.9 and N18.3.

Hypertension, hypertensive center illness, and chronic kidney illness: I13

  • Abstract
  • Essential (main) hypertension: I10
  • Hypertension and hypertensive heart affliction: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive heart disease, and chronic kidney illness: I13
  • Tobacco employ or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-10
  • References

To confuse matters farther, if the patient has all iii weather (hypertension, heart disease, and chronic kidney disease), and so yous need to document the relationship between the hypertension and heart illness but assume the causal relationship betwixt hypertension and chronic kidney disease. The documentation requirements are the aforementioned as what was outlined in a higher place.

The codes for the three-affliction combination are numerically arranged by the caste of chronic kidney disease rather than the presence or absence of heart failure:

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

  • I13.10, Hypertensive heart and chronic kidney disease without heart failure with phase 1 through phase 4 chronic kidney illness, or unspecified chronic kidney illness,

  • I13.11, Hypertensive heart and chronic kidney disease without heart failure with stage 5 chronic kidney disease, or finish-stage renal affliction,

  • I13.2, Hypertensive heart and chronic kidney affliction with heart failure and with phase 5 chronic kidney disease, or finish-stage renal disease.

Equally with the two-combination codes, all of the three-combination codes require boosted coding from the N18 series to place the stage of kidney disease. The 3-combination codes that include center failure also require boosted coding from the I50 series to specify the type and acuity of the failure.

Instance: The 55-year-sometime female person in the above example presents to your office with some pedal edema, and on examination y'all also detect some mild crackles in the base of operations of her lungs. You lot order an echocardiogram that documents mild systolic center failure. Her eGFR has remained stable. You update her diagnostic codes to I13.0 (Hypertensive heart and chronic kidney disease with heart failure and with phase 1 through 4 chronic kidney disease, or unspecified chronic kidney disease), I50.21 (Systolic, congestive, heart failure, acute), and N18.three (Chronic kidney disease, stage iii, moderate).

Tobacco use or exposure in individuals with hypertensive diseases

  • Abstract
  • Essential (chief) hypertension: I10
  • Hypertension and hypertensive centre affliction: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive heart disease, and chronic kidney disease: I13
  • Tobacco use or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-10
  • References

All of the hypertension codes require an additional ICD-ten code if the patient is a current or onetime tobacco user. In most cases, you would utilize one of the following codes found in chapter 5, "Mental, Behavioral, and Neurodevelopmental Disorders":

  • F17, Nicotine dependence,

  • F17.20, Unspecified,

  • F17.21, Cigarettes,

  • F17.22, Chewing tobacco,

  • F17.29, Other tobacco product.

Each of these four categories has a required sixth character:

  • 0, uncomplicated,

  • 1, in remission,

  • iii, with withdrawal,

  • 8, with other specified nicotine-induced disorder,

  • nine, with unspecified nicotine-induced disorder.

If yous have not documented that a patient who uses tobacco is "dependent," then you would instead use the code for tobacco use (Z72.0). The difference is not well-defined, but the Centers for Disease Control and Prevention's website states, "Tobacco use tin can lead to tobacco/nicotine dependence and serious health problems … Tobacco/nicotine dependence is a chronic condition that oft requires repeated interventions."

Occupational and environmental exposure to tobacco should also be coded if the provider believes these are influencing the patient's health status. The codes are as follows:

  • Z57.31, Occupational exposure to environmental tobacco smoke,

  • Z72.0, Bug related to lifestyle, tobacco use,

  • Z77.22, Exposure to ecology tobacco smoke (includes 2d-manus smoke exposure and passive smoking),

  • Z87.891, Personal history of nicotine dependence.

The ICD-10 manual partially explains the divergence between Z87.891, "Personal history of nicotine dependence," and F17.211, "Nicotine dependence, cigarettes, in remission." It states that a personal history lawmaking should be used if a patient's condition no longer exists and is not being treated only has the potential to recur and, therefore, may require continuous monitoring. The remission code would be advisable if a patient is actively using a product to stop smoking. Once the patient has stopped using such products, it is upwardly to the provider to make up one's mind when the patient'southward status would motion from "in remission" to "personal history of."

Coding for secondary hypertension: I15

  • Abstract
  • Essential (primary) hypertension: I10
  • Hypertension and hypertensive heart illness: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive eye disease, and chronic kidney disease: I13
  • Tobacco utilise or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-10
  • References

Although the main focus of this commodity has been essential hypertension, including comorbidities of heart failure and chronic kidney disease, there may be some patients in the master intendance setting who have hypertension secondary to other disease states. In these cases, providers cannot use the hypertension ICD-10 codes discussed above. Instead, use the post-obit codes:

  • I15.0, Renovascular hypertension,

  • I15.1, Hypertension secondary to other renal disorders,

  • I15.2, Hypertension secondary to endocrine disorders,

  • I15.eight, Other secondary hypertension,

  • I15.9, Secondary hypertension, unspecified.

The five secondary hypertension codes require that you too lawmaking the underlying condition. ICD-10 typically permits either the underlying condition or the secondary hypertension code to be listed kickoff depending on the reason for the patient run into. The exception to this is I15.eight, Other secondary hypertension. Because this is an "other" code, the "other" condition must be coded get-go.

Adapting to ICD-x

  • Abstruse
  • Essential (primary) hypertension: I10
  • Hypertension and hypertensive heart disease: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive heart affliction, and chronic kidney affliction: I13
  • Tobacco use or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-10
  • References

If this introduction to the new hypertension codes has elevated your blood force per unit area, finish and take a deep breath. ICD-10 coding is a big adjustment, but it will get easier with time and practice. For more help, see the serial overview and expect for time to come articles in FPM.

ARTICLES IN FPM'S ICD-ten SERIES

You can admission the following articles in FPM's ICD-10 topic collection:

"ICD-10: Major Differences for Five Common Diagnoses," FPM, September/October 2015.

"ICD-10 Sprains, Strains, and Automobile Accidents," FPM, May/June 2015.

"Digesting the ICD-10 GI Codes," FPM, January/Feb 2015.

"Coding Common Respiratory Problems in ICD-10," FPM, November/Dec 2014.

"ICD-10 Simplifies Preventive Care Coding, Sort Of," FPM, July/August 2014.

"ICD-10 Coding for the Undiagnosed Problem," FPM, May/June 2014.

"How to Document and Lawmaking for Hypertensive Diseases in ICD-10," FPM, March/April 2014.

"ten Steps to Preparing Your Office for ICD-10 – At present," FPM, January/February 2014.

"Getting Ready for ICD-10: How It Will Bear upon Your Documentation," FPM, November/December 2013.

"The Anatomy of an ICD-x Code," FPM, July/August 2012.

"ICD-10: What You Need to Know At present," FPM, March/April 2012.

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About the Author

Dr. Beckman, a family physician, is vice president/chief medical officer for a health insurance company in Milwaukee, Wis.

Writer disclosure: no relevant financial affiliations disclosed.

Copyright © 2014 by the American Academy of Family Physicians.
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