ICD-10-CM Coding: Hypertensive Heart Disease, Chronic Kidney Disease, and Hypertension

ICD-10-CM Coding: Hypertensive Heart Disease, Chronic Kidney Disease, and Hypertension

Hypertensive heart disease refers to a group of disorders that includes heart failure, ischemic heart disease, and left ventricular hypertrophy. It is the number one cause of death associated with high blood pressure. Documentation must state (heart failure due to hypertension) or imply a causal relationship (hypertensive heart failure) to assign a code from category I11, Hypertensive heart disease.

Guidelines state that there is a presumptive cause-and-effect relationship between hypertension and chronic kidney disease.

If a patient has all three conditions present—hypertension, heart disease, and chronic kidney disease—the guidelines state that the connection must be made for the heart disease and hypertension, but not for the CKD and hypertension.

EXAMPLE 1:

Assessment: 1. Hypertension 2. Chronic diastolic congestive heart failure.

I10 Essential (primary) hypertension

I50.32 Chronic diastolic (congestive) heart failure

Becuase there is no causal relationship indicated, the two conditions are coded separately.

EXAMPLE 2:

Assessment: Hypertension with hypertensive chronic diastolic congestive heart failure

I11.0 Hypertensive heart disease with heart failure

I50.32 Chronic diastolic (congestive) heart failure

The causal relationship is indicated; therefore, the first-listed code is now different. The instructional note under code I11.0 states that the second code is still necessary to identify the type of heart failure.

EXAMPLE 3:

Patient is a 75-year-old female with hypertension and stage 3 CKD with a creatinine of 1.8.

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

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

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

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John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

7 Responses to “ICD-10-CM Coding: Hypertensive Heart Disease, Chronic Kidney Disease, and Hypertension”

  1. rsoujanyaa says:

    Very useful stuff

  2. Srikanth says:

    How to code hypertension with nephropathy?

  3. Srikanth says:

    can we code I11.9 for hypertension with CAD?

  4. Carol says:

    can we code I11.9 for hypertension with CAD?

  5. Amanda says:

    This is not correct. Per ICD 10 CM guidelines the two conditions are linked by the term “with” in the Alphabetic Index. These conditions should be coded as related even in the absence of provider documentation explicitly linking them. Unless documentation clearly states the conditions are unrelated. Which means the first example provided is wrong- We assume there is a causal relationship.

    As for CAD there is no “with” (besides angina) that would indicate this.

    The ICD 10 guidelines state conditions classified to I50.x and I51.4-I51.9, which does not include CAD.

  6. Balaji K says:

    Hi All,

    I’m having an doubt on this topic. When patient comes for Chest pain then it leads Heart failure as Final Dx. Patient already having Chronic condition like CKD and HTN. Shall we Code Combo for this? Please Explain

  7. Melani Brooks says:

    I am Heart Failure nurse and we always educate Acute Heart Failure patients. This ICD code has burned us a several times…patient comes in with Hypertension, CKD-chronic, and remote Heart Failure (last patient this happened to didn’t have an exacerbation of HF since 2014 and No Acute heart failure this admission) = I130. We then do not teach this patient because we are only looking for patients with Acute heart failure and they failed our screening. Because of this, we don’t make sure they are on the correct medications for Heart Failure Get with the Guidelines recommendations, we miss a follow-up phone call and referral to the Heart Failure Clinic…of which they aren’t appropriate to go to because they did not have ACUTE Heart Failure. I don’t know how to screen for these patients and I really don’t want to go teach a person for Heart Failure when that isn’t their issue today. Anyone have any ideas to help. Thanks for your input.

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