Cardiology Coding Alert

Hint: Report I27.0 for primary pulmonary hypertension.

In Cardiology Coding Alert Volume 25, Issue 10, in the article “Answer 6 FAQs to Ensure Clean Hypertension Claims,” you learned all about different types of hypertension including hypertensive chronic kidney disease (CKD) and hypertensive heart and CKD. This issue, learn even more about other types of hypertension such as pulmonary and transient.

Follow these handy rules to keep your hypertension coding in tip-top shape.

Rule 1: Remember What Hypertension is

Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries. As defined in part 1 of this article series, hypertension occurs when blood pressure is too high. Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats.

Providers diagnose hypertension if, when blood pressure is measured on two different days, the systolic blood pressure readings on both days is ≥140 mmHg and/or the diastolic blood pressure readings on both days is ≥90 mmHg, says Rebecca Sanzone, CPC, CPMA, quality assurance specialist at St. Vincent Medical Group/Accension Health and coding consultant at the American College of Cardiology.

Rule 2: Report Hypertensive Heart Disease This Way

If your cardiologist documents that the patient has hypertension, along with heart conditions classified to categories I50.- (Heart failure), I51.4 (Myocarditis, unspecified)-I51.7 (Cardiomegaly), I51.89 (Other ill-defined heart diseases), or I51.9 (Heart disease, unspecified), report either I11.0 (Hypertensive heart disease with heart failure) or I11.9 (Hypertensive heart disease without heart failure), depending upon the documentation, according to the ICD-10-CM guidelines. If the patient has heart failure, also report an additional code from category I50.- to identify the exact heart failure type.

However, if your cardiologist documents that the heart conditions I50.-, I51.4-I51.7, I51.89, and I51.9 are not related to the patient’s hypertension, you would code those conditions separately and sequence according to the circumstances of the admission or encounter.

Rule 3: Focus on Codes for Pulmonary Hypertension

If the cardiologist diagnoses the patient with pulmonary hypertension, you should report one of the following codes:

• I27.0 (Primary pulmonary hypertension)
• I27.1 (Kyphoscoliotic heart disease)
• I27.20 (Pulmonary hypertension, unspecified)-I27.29 (Other secondary pulmonary hypertension)
• I27.81 (Cor pulmonale (chronic))-I27.9 (Pulmonary heart disease, unspecified)

Rule 4: Master Rules for Transient Hypertension

If your cardiologist documents transient hypertension, report R03.0 (Elevated blood-pressure reading, without diagnosis of hypertension), unless the patient has an established diagnosis of hypertension, per the ICD-10-CM guidelines.

Caution: If the patient has transient hypertension of pregnancy, look to O13,- (Gestational (pregnancy-induced) hypertension without significant proteinuria) or O14.- (Pre-eclampsia) instead of R03.0.

Rule 5: Save These Expert Documentation Tips

Our experts also offered advice you can follow when you are reporting hypertension. Keep these tips handy to make sure you are submitting your claims correctly.

Tip 1: “I am from a congenital heart disease (CHD) world. How we report hypertension is quite different than the acquired world,” says Julie-Leah J. Harding, CPC, CPMA, CEMC, CCC, CRC, RMC, PCA, CCP, SCP-ED, CDIS, director of revenue operations and billing compliance-cardiovascular surgery at Boston Children’s Hospital in Boston, Massachusetts. “Typically with CHD, hypertension and pulmonary hypertension are secondary, as is the case with coarctation Q25.1 (Coarctation of aorta). We frequently report I15.8 (Other secondary hypertension). If the patient has congenital malformations of the pulmonary veins (Q26.- , Congenital malformations of great veins), the pulmonary hypertension is secondary (I27.29, Other secondary pulmonary hypertension).”

Tip 2: When reporting hypertension, you must know if there is kidney disease with or without heart failure. If the patient’s hypertension is caused by kidney disease, your provider needs to document that, Sanzone says. You would not code hypertension and kidney disease as separate codes, but would pick the most appropriate “combined code.” The same goes for a hypertensive crisis. It is also important to know if the hypertension is primary or if other factors are involved.

Tip 3: “In order for the coder to be able to collect the details needed for selecting the correct codes for hypertension, the provider must document if the patient has congestive heart failure and/or kidney disease,” says Carol Hodge, CPC, CPMA, CDEO, CCC, CEMC, CPB, CFPC, COBGC, senior documentation specialist at St. Joseph’s/Candler Medical Group. “If so, then then the provider needs to document the type of heart failure and/or the stage of kidney disease. These are considered causal unless the provider documents that it is not causal.”

Tip 4: Correctly coding for hypertension is very detailed. In the ICD-CM-10 book under hypertension, there are multiple codes for hypertension including primary hypertension, hypertensive heart disease, hypertensive CKD, and others, Hodge says

Coders should pay close attention to the multiple “code also” and “ use additional code notes” for hypertension, according to Hodge. For example, hypertensive heart and CKD require the hypertension code, the type of heart failure, and the stage of kidney disease.