4 Tips for Accurate Pulmonary Hypertension Coding
PH WHO groups key to understanding I27 codes.
Despite the fact that pulmonary hypertension (PH) is a “frequently identified … highly morbid condition … associated with increased mortality, hospitalizations and financial burden,” it is “rarely coded in the EHR [Electronic Health Record]” according to a recent article published in the Journal of Cardiac Failure.
What, then, can you and your provider do to ensure that this condition is coded, and ¾ equally important ¾ coded correctly? Here are four ways you can improve your PH coding.
Know What PH Is
The Pulmonary Hypertension Association (PHA) defines PH as “a general term used to describe high blood pressure in the lungs from any cause.” The high blood pressure thickens the lung’s arteries, causing the right side of the heart to work harder than normal to keep blood pumping into the lungs. Eventually, the condition leads to right-side heart failure.
The World Health Organization (WHO) classifies PH into five different groups, known as the PH WHO Groups. Knowing the groups is important for a coder, as not only do they help you understand the cause of the condition, but they also help you determine the correct ICD-10-CM code or codes you need to document PH accurately.
Know the different I27 Other pulmonary heart disease
Group 1: This group is reserved for primary PH, or pulmonary arterial hypertension (PAH), as it is also known. PAH, is further broken down into three different types: Idiopathic PAH, which has no clear cause; Heritable PAH, which is a genetic condition; and Other PAH, which results from drug use and from other conditions, such as liver disease, and connective tissue diseases such as lupus and HIV. Both idiopathic PH and heritable PH are listed as synonyms in this ICD-10 category.
Associated ICD-10-CM Code: I27.0 Primary pulmonary hypertension
Group 2: Groups 2-5 refer to secondary PH, beginning with “the most common form of PH,” according to the PHA. Group 2 PH occurs when problems with the left side of the heart cause blood to back up, raising pressure in the lung.
Associated ICD-10-CM Code: I27.22 Pulmonary hypertension due to left heart disease
Group 3: PH in this group is a result of numerous other obstructive and restrictive lung diseases. These include chronic lung disease, chronic obstructive pulmonary disease (COPD), emphysema, interstitial lung disease, sleep apnea, and hypoxia (low oxygen levels).
Associated ICD-10-CM Code: I27.23 Pulmonary hypertension due to lung diseases and hypoxia
Group 4: Known as chronic thromboembolic pulmonary hypertension (CTEPH), this PH group is caused by blood clots in the lungs. The clots, in turn, cause scarring, which restricts blood flow in the lungs, causing the right side of the heart to work harder.
Associated ICD-10-CM Code: I27.24 Chronic thromboembolic pulmonary hypertension
Group 5: As its associated ICD-10 code suggests, this is a catch-all category of PH caused by other conditions. In this group, however, the causal connection between the conditions is not well understood. The conditions, according to the PHA, include “sarcoidosis, sickle cell anemia, chronic hemolytic anemia, splenectomy (spleen removal) and certain metabolic disorders.”
Associated ICD-10 Code: I27.29 Other secondary pulmonary hypertension
Know the guidelines associated with I27 and the Code also
With the exception of Group 1 PH, the ICD-10 codes for the PH groups include Code also instructions, which is not surprising given that the conditions in each group have their cause in other conditions. This is reinforced by ICD-10 guideline I.C.9.a.11, which tells you to “code any associated conditions or adverse effects of drugs or toxins for any of the secondary pulmonary hypertension codes (I12.1, I27.-).”
Importantly, you will also need to sequence the codes “based on the reason for the encounter, except for adverse effects of drugs,” per the guidelines. So, for example, if during an encounter with a patient regarding problems associated with rheumatoid arthritis your provider also discusses the patient’s shortness of breath, associated with the secondary PH and caused by the rheumatoid arthritis, you would sequence M05.- Rheumatoid arthritis first, followed by I27.21.
Know the I27 Excludes1 notes
Fortunately, these are few and, like all Excludes1 notes, they only apply “when two conditions cannot occur together.” Under I27.0, for example, you cannot code for certain secondary PH conditions or for P29.30 Pulmonary hypertension of newborn. And under I27.2-, you cannot code for I27.83 Eisenmenger’s syndrome, a congenital heart defect where a hole between two heart chambers creates abnormal blood flow between the heart and lungs, eventually thickening the lungs’ arteries and creating PH.