Cardiology Coding Alert

ICD-10-CM narrows your code options from 12 to 4 for hypertensive heart and CKD.

You can expect ICD-10-CM to provide you with combination codes for certain chronic conditions just as ICD-9-CM does, but that doesn't mean the code definitions will be precisely the same.

To see a practical example, review the codes below, which you assign when a patient has both hypertensive heart disease (documentation indicates hypertension causes heart disease) and hypertensive chronic kidney disease (hypertension with chronic kidney disease [CKD] even if no relationship is indicated in the documentation).

ICD-9 coding rules: The terms "benign" and "malignant" feature in the ICD-9 hypertensive heart disease codes. When the physician doesn't document benign or malignant, you must choose an "unspecified" code.

Additionally, you should report the heart failure type (428.x), if known, and the CKD stage (585.x) as secondary codes.

The ICD-9 codes include:

• 404.0x, Hypertensive heart and chronic kidney disease; malignant
• 404.1x, ... benign
• 404.9x, ... unspecified.

ICD-9 fifth digit options are:

• 0, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified
• 1, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified
• 2, without heart failure and with chronic kidney disease stage v or end stage renal disease
• 3, with heart failure and with chronic kidney disease stage v or end stage renal disease.

ICD-10 changes: You'll see a switch from 12 ICD-9 options to four ICD-10 options. This is because under ICD-10 you won't have to distinguish between "benign" and "malignant."

ICD-10 2011 codes include:

• I13.0, Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
• I13.10, Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
• I13.11, Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
• I13.2, Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease.

Documentation: Although you won't have to scour the documentation for "benign" or "malignant" to choose an ICD-10 code, you still will need to use an additional code to identify heart failure type (I50.-) and CKD stage (N18.1-N18.4, N18.9).

Coder tips: If you've discovered a method of reminding the team to code heart failure and CKD types in addition to 404.xx codes, stick with it and apply it to I13.- when ICD-10 goes into effect. Also, let the coding team know that if the documentation doesn't mention heart failure and doesn't mention the stage of CKD, the appropriate code will be I13.10, which has this note: "Hypertensive heart disease and hypertensive chronic kidney disease NOS."

Remember: When ICD-10-CM goes into effect on Oct. 1, 2013, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.