ICD-10-CM Medical Coding: Hypertensive Diseases
ICD-10-CM Codes: This lecture reviews medical coding for hypertensive diseases along with chapter-specific guidelines for hypertension.
Guest Author
Guest Author: Donna Maher, MS, RHIA
The lecture below was written by guest author Donna Maher, who is a faculty member at Renton Technical College teaching medical billing and coding.
Medical illustrations were created and provided by Donna Maher and EZmed.
💯 How to Pass Your Classes & Exams!
Become a member to access hundreds of pages of study guides, PDF lectures, & flashcards!
Instant access to a members-only page of ALL the flashcards, study guides, and PDF lectures. Cancel anytime.
ICD-10-CM Codes: Chapter-Specific Guidelines
This lecture will focus on Chapter 9: Diseases of the Circulatory System (I00-I99) from ICD-10-CM Official Guidelines for Coding and Reporting, FY 2023.
The lecture will specifically cover items from:
Section I.C.9.a. (Hypertension)
All Chapter 9 guidelines are from ICD-10-CM Official Guidelines for Coding and Reporting, FY 2023.
ICD-10-CM Codes: This lecture reviews Chapter 9: Diseases of the Circulatory System (I00-I99), specifically items from Section I.C.9.a. Hypertension.
ICD-10-CM: Hypertensive Diseases
Let’s start with a general overview of diagnostic coding and hypertensive diseases, and then we will walk through example cases below.
Diagnostic Coding Overview
When looking up diagnostic codes, you must first identify the main term in the diagnostic statement.
Then, look up the main code in the Alphabetical Index and verify the code in the Tabular List.
Diagnostic codes can have 3 to 7 digits and selecting the correct level of digits is found by reading the 3-digit category code description and applying the directives to your code selection.
This lecture will focus on coding hypertensive disease.
What is Hypertensive Disease?
Per the Official Guidelines for Coding and Reporting (OGCR), there is a causal relationship between hypertension, heart involvement, and kidney disease, even when the provider does not state the relationship.
This is vital to remember when coding hypertensive disease, as the lack of documentation does not prevent the use of hypertensive codes.
The term “Hypertensive” (as used in hypertensive heart disease and hypertensive chronic kidney disease - see sections below) means the condition is related to hypertension, or caused by or due to hypertension.
Hypertensive disease refers to a specific set of diseases that are assumed to be caused by hypertension.
The effects of hypertensive disease include strokes, heart disease, heart attacks, and kidney disease.
While atherosclerotic coronary heart disease may have a hypertensive element, it must have documentation providing the causal effect between hypertension and atherosclerotic heart disease.
ICD-10-CM (ICD10) hypertension codes do not include hypertensive disease complicating pregnancy, childbirth, and the puerperium (postpartum period), as well as hypertension involving vessels of the brain, and hypertension involving vessels of the eye.
These conditions, while hypertensive disease, do not fall under ICD10 combination conditions.
Coding for Hypertensive Disease
When coding hypertension or hypertensive disease, use only one code from I10, I11, I12, or I13.
These codes have hypertension or hypertensive in the code description and do not require a separate code for any hypertensive disease.
Hypertensive codes I11, I12, and I13 are sequenced before those additional codes for hypertensive diseases.
The codes also include additional code digits to specify the combination of hypertension and heart disease, and chronic kidney disease.
The additional for heart and kidney diseases require additional digits in each code.
Read the entire code description before assigning a separate code for the directive “use additional code.”
Because of the large number of Americans with hypertensive disease, coders frequently code the condition.
Complex diagnoses can be given to patients who have substantial disease processes and chronic conditions.
One task of the coder is to identify the reason for the encounter and locate codes based on those reasons.
ICD-10-CM codes are diagnostic codes answering the question “what was wrong with the patient” or “why did the patient walk in the door” to the office?
Select the primary reason for the encounter as the first-listed code.
ICD-10-CM Coding for Hypertensive Disease: There is a causal relationship between hypertension, heart disease, and chronic kidney disease.
Practice Example Cases
Let’s look at examples of coding hypertensive disease below, starting with essential (primary) hypertension.
The following cases have additional codes indicating the chronic condition.
The cases below are simplified to illustrate the use of hypertensive codes.
In many cases, patients will have additional conditions, such as cancer or diabetes, that will require coding.
The provider’s professional assessment and diagnosis will form the diagnostic statement.
The diagnostic statement is the phrase used in locating the diagnoses.
Essential Hypertension (I10)
The first example will focus on coding for essential (primary) hypertension (I10).
Hypertension is the easiest code in ICD10 because the hypertension code is I10.
Hyper-TEN-sion is a mnemonic to help remember the code number.
A qualified healthcare provider must diagnose hypertension with a blood pressure at or above 130/80 (1, 2).
In ICD10, there is no difference in the codes for essential hypertension, benign hypertension, controlled hypertension, and uncontrolled hypertension.
All types of primary hypertension are coded to I10.
In addition, an elevated blood pressure reading does not qualify as hypertension and is coded elsewhere.
(1) National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention Sources
(2) The American Heart Association/American College of Cardiology Blood Pressure Guidelines
Example Case
This male 67-year-old established patient presents for a routine office visit to assess his hypertension control with medication.
The patient has no concerns and feels well today.
His blood pressure is 141/88, consistent with previous readings.
After discussion, the patient feels he is doing quite well with his current medication and does not wish to increase the dosage.
Diagnosis: Hypertension, stable on medication.
The reason for the encounter was hypertension.
There is no other hypertensive disease.
The code is I10.
One disease, One code.
ICD-10-CM Codes: The medical code for essential (primary) hypertension is I10.
Hypertensive Heart Disease (I11)
Heart failure, an inability to pump sufficient blood, has an assumed causal relationship to hypertension.
ICD I11 (hypertension) states that any condition in I50- or I51-, heart failure, shall be used as an additional code.
Furthermore, if there is no related heart failure, I11.9 is coded without additional I50 or I51 codes.
Example Case
This male 67-year-old established patient presents for a routine office visit to assess his hypertensive heart failure.
The patient has no concerns and feels well today.
His blood pressure is 141/88, consistent with previous readings.
After discussion, the patient feels he is doing quite well with his current medication and does not wish to increase the dosage.
Diagnosis: Hypertensive heart failure, stable on medication.
The reason for the encounter was hypertensive heart failure.
Remember, “hypertensive” means the condition is due to hypertension.
The patient has hypertension with heart failure.
Though the relationship between heart failure and hypertension is not identified, OGCR states that a causal relationship is assumed.
Going to hypertensive heart failure in the ICD10 manual, code I11.0 - hypertensive heart disease with heart failure is found.
I11 has a coding directive from Section I.C.9.a. stating to use additional code to identify the type of heart failure (I50.-, I51.4-I51.7, I51.89, I51.9).
The codes for this case are I11.0- Hypertensive heart disease with heart failure.
In this case, we have unspecified heart failure, I50.9.
The correct codes are I11.0, I50.9.
Two diseases, Two codes.
ICD-10-CM Codes: The medical code for hypertensive heart disease is I11 plus I50 specific heart disease
Hypertensive Chronic Kidney Disease (I12)
Assign codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present.
See Section I.C.14. Chronic kidney disease.
ICD I12 (hypertension) states that any condition from N18 chronic kidney disease shall be used as an additional code.
If the stage of kidney disease is unspecified, use code N18.9.
Example Case
This male 67-year-old established patient presents for a routine office visit to assess his hypertension and chronic kidney disease.
The patient has concerns about going on dialysis.
His blood pressure is 141/88.
After a discussion about starting dialysis, the patient feels he is doing quite well with his current medication and does not wish to start dialysis.
Diagnosis: Hypertensive chronic kidney disease, stage 4.
The reason for the encounter was hypertension and chronic kidney disease, stage 4.
Though the provider did not identify the relationship between chronic kidney disease and hypertension, the OGCR states that a causal relationship is assumed.
Going to the ICD10 manual, code I12.9 - Hypertensive chronic kidney disease with stage 4 chronic kidney disease or end-stage renal disease and the coding directive to use an additional code to identify the stage of chronic kidney disease.
The correct codes are I12.9, N18.4.
Two diseases, Two codes.
Note that N18.0 is stage 5 kidney disease and not stage 4; remember to read the code description to ensure accurate coding. Stage 4 kidney disease is coded to N18.4.
ICD-10-CM Codes: The medical code for hypertensive chronic kidney disease is I12 plus N18 specific level of kidney disease
Hypertensive Heart and Chronic Kidney Disease (I13)
Assign codes from category I13, Hypertensive heart and chronic kidney disease when there is hypertension with both heart and kidney involvement.
The previous coding requirements for additional codes indicating heart failure and the stage of chronic kidney disease are also required.
As with I11 and I12 codes, assign the appropriate code for heart failure and the stage of kidney disease.
I13 has a coding directive from Section I.C.9.a. stating to use an additional code to identify the level of chronic kidney disease (N18.-) and an additional code to identify the degree of heart failure.
Example Case
This male 67-year-old established patient presents for a routine office visit to assess his hypertension and congestive heart failure and worsening chronic kidney disease.
The patient has concerns about going on dialysis.
His blood pressure is 141/88; he has stable heart failure.
After a discussion about starting dialysis, the patient feels he is doing quite well with his current medication and does not wish to start dialysis.
Diagnosis: Hypertension, congestive heart failure, chronic kidney disease, stage 4.
The reason for the encounter was hypertensive chronic kidney disease and heart failure.
Though the relationship between chronic kidney disease, heart failure, and hypertension is not identified, OGCR states that a causal relationship is assumed.
Hypertensive heart failure with kidney disease leads to I13.
I13 has a coding directive from Section I.C.9.a. stating to use an additional code to identify the type of heart failure (I50.-) and an additional code to identify the level of chronic kidney disease (N18.-)
Three diseases, Three codes.
ICD-10-CM Codes: The medical code for hypertensive heart and chronic kidney disease is I13 plus I50 for specific heart disease plus N18 for specific kidney disease
Summary
Coding for hypertensive disease can be very complex.
Remembering that a causal relationship does not need to be documented to code hypertensive disease.
Only if the provider states there is no relationship between the conditions are hypertensive diseases considered unrelated and coded separately.
The series I11, I12, and I13 require additional digits to explain the hypertensive disease(s).
The series also requires additional digits for the hypertensive disease to indicate the degree or stage.
I10, hypertension, is the easiest code to remember and is a single code.
ICD-10-CM Codes: Summary of hypertensive disease medical codes for hypertension with or without heart disease and chronic kidney disease.
Before You Go….
Leave a comment down below if you enjoyed the lecture!
Save time studying and reviewing - Get free lectures and videos sent right to your inbox below!
Follow EZmed below!
YouTube Channel: EZmed - Animations and videos that simplify medicine and science
Instagram: @ezmedlearning - High yield exam content
Pinterest: ezmedlearning - Easy illustrations and flashcards
ReferencesCenters for Medicare & Medicaid Services; ICD-10-CM Official Guidelines for Coding and Reporting FY 2023; https://www.cms.gov/medicare/icd-10/2023-icd-10-cm; (2023)Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention Sources; Facts About Hypertension; https://www.cdc.gov/bloodpressure/facts.htm; (2023)American Medical Association; What is High Blood Pressure; The American Heart Association/American College of Cardiology; https://www.ama-assn.org/delivering-care/hypertension/what-high-blood-pressure; (2023)