ICD-10-CM Diseases of the Circulatory System

Be ready to transition from 400.x series codes to the “I13” category when ICD-10-CM takes effect.

By Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CEMC, CPMA, COBGC, CPCD, CCS-P

This month’s focus is “Understanding the ICD-10-CM draft guidelines for Diseases of the Circulatory System,” found in Chapter 9 of ICD-10-CM and related to coding the combination of hypertensive heart and renal disease.

Hypertensive Heart And Renal Disease

Hypertensive heart and renal disease are reported with combination codes that include hypertension, heart disease and renal disease. Once ICD-10-CM takes effect, these codes will appear in category I13.

The “includes” note in category I13 means that the condition from category I11 is included in category I13. If the patient has hypertension, heart disease and renal disease, a code from this category should be reported. In addition, coding professionals should also report a code from category I50 for patients with heart failure.

Additional code: If the patient is diagnosed with both acute and chronic renal failure, coders will also report a code for the acute renal failure from category N17 or N19. In ICD-9-CM, the term “chronic kidney disease” replaced the term “renal disease” in 2006. Since ICD-10-CM is still in the draft guideline format, the terminology from renal disease to chronic kidney disease probably will change in final guidelines.

Review The Comparison Between ICD-9-CM And ICD-10-CM

ICD-9-CM differentiates among benign, malignant and unspecified conditions, whereas ICD-10-CM does not. The guidelines in ICD-9-CM include an additional instructional note to “Use an additional code to identify the stage of chronic kidney disease.” The draft guidelines for ICD-10-CM do not require the additional code for this condition, but may require it when final guidelines are implemented. Both ICD-9-CM and ICD-10-CM require an additional code to report the type of heart failure that the patient has.

ICD-9-CM to ICD-10-CM Crosswalk

 ICD-9-CM  ICD-10-CM
404.0 Hypertensive heart and chronic kidney disease, malignant404.00 Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified404.01 Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified

404.02 Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage V or end stage renal disease

404.03 Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease

404.1 Hypertensive heart and chronic kidney disease, benign

404.10 Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified

404.11 Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified

404.12 Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage V or end stage renal disease

404.13 Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease

404.9 Hypertensive heart and chronic kidney disease, unspecified

404.90 Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified

404.91 Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified

404.92 Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage V or end stage renal disease

404.93 Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease

I13 Hypertensive heart and renal diseaseIncludes: any condition in I11.-with any condition in I12.-cardiorenal disease cardiovascular renal diseaseI13.0 Hypertensive heart and renal disease with heart failure

Use additional code to identify type of heart failure (I50.-)

I13.1 Hypertensive heart and renal disease with chronic renal failure

I13.2 Hypertensive heart and renal disease with both heart failure and chronic renal failure

Use additional code to identify type of heart failure (I50.-)

I13.9 Hypertensive heart and renal disease, unspecified

Example: A patient is admitted to the hospital with acute diastolic heart failure due to hypertension with end stage renal disease (ESRD).

 ICD-9-CM  ICD-10-CM
404.91 Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified428.0 Congestive heart failure, unspecified585.6 End stage renal disease I13.2 Hypertensive heart and renal disease with both heart failure and chronic renal failureI50.31 Acute diastolic (congestive) heart failureN18.0 End-stage renal disease

Rationale: Because the guidelines specify reporting both the acute heart failure and the acute renal failure in addition to the hypertensive heart and renal disease, all three codes would be reported, according to ICD-9-CM and ICD-10-CM guidelines.

Secondary Hypertension

Secondary hypertension is caused by an underlying condition, but according to coding guidelines, secondary hypertension is not a manifestation. Two codes are required when coding from category I15: a code to identify the underlying etiology and a code from I15 to identify the hypertension. Sequencing of the codes is based upon the reason for the encounter.

There are two “excludes” notes:

Excludes1: postoperative hypertension (I97.3);

Excludes2: secondary hypertension involving vessels of brain (I60-I69) and secondary hypertension involving vessels of eye (H35.0).

Note: With the Excludes1 note present, you may not use 197.3 in addition to the code from category I15 for secondary hypertension. The Excludes2 note allows reporting I15 (secondary hypertension) when the underlying etiology is present.

In ICD-9-CM, secondary hypertension is reported with one code from category 405.xx to identify what caused the secondary hypertension. Secondary hypertension due to glomerulosclerosis is an exception, and that condition is coded as 403.xx.

Example

A patient is treated for malignant renal occlusion secondary to hypertension.

 ICD-9-CM  ICD-10-CM
405.09 Other secondary hypertension, malignant N28.0 Ischemia and infarction of kidney  renal artery occlusionI15.0 Renovascular hypertension

In ICD-9-CM, only one code is required, whereas with ICD-10-CM, the combination code does not exist. Based upon ICD-10-CM guidelines, the renal artery occlusion must be reported as well as the renovascular hypertension.

SIDEBAR: ICD-10-CM Update

On Feb. 15, 2007, Senators Norm Coleman of Minnesota and Evan Bayh of Indiana introduced Senate bill S.628 (Critical Access to Health Information Technology Act of 2007) that, if passed, would provide grants for rural health information technology development. The bill is intended to offset the costs of incorporating new technology for health care purposes in rural facilities that cannot afford the cost.

The final rule is expected no later that Oct. 1, 2008, and includes provisions to implement ICD-10-CM and ICD-10-PCS as replacements to the three volumes of the International Statistical Classification of Diseases, 9th revision, Clinical modification (referred to as ICD-9-CM) under section 1172(c) of the Social Security Act (42 U.S.C. 1320d-2(c). The language of the bill requires implementation of ICD-10-CM and ICD-10-PCS no later than Oct. 1, 2011.

The bill states, “Adoption of ICD-10-CM and ICD-10-PCS will occur not later than October 1, 2008, and compliance with such rules shall apply to transactions occurring on or after October 1, 2011 and covered entities and health technology vendors under HIPAA shall begin the process of planning for and implementing the updating of the new versions and editions.”

The bill reinforces the idea that the time is now to begin preparations for bringing the new code sets into your practice and/or facility to ensure seamless integration.

2017-code-book-bundles-728x90-01

Latest posts by admin aapc (see all)

Leave a Reply

Your email address will not be published. Required fields are marked *