Cardiology Coding Alert


Conquer Different Types of Hypotension to Submit Clean Claims

Hint: Orthostatic hypotension is same as postural.

You know that ICD-10-CM is tricky to report because so many different diagnosis codes exist. To choose the appropriate ones for your claims, you must pay attention to numerous details in the medical documentation. Reporting hypotension is no different.

Take a look at how you should handle hypotension in your cardiology practice.

Understand What Hypotension Is

Low blood pressure, also known as hypotension, is a blood pressure under 90/60 millimeters of mercury, says Rebecca Sanzone, CPC, CPMA, quality assurance specialist at St. Vincent Medical Group/Accension Health and coding consultant at the American College of Cardiology.

Low blood pressure is only a problem if a person develops symptoms, which can include dizziness, fainting or shock. In severe cases, it can be life-threatening. But low blood pressure without these serious symptoms is usually not unhealthy.

If the documentation indicates unspecified hypotension, then the correct ICD-10-CM code is I95.9 (Hypotension, unspecified), says Catherine Brink, BS, CPC, CMM, president of Healthcare Resource Management in Spring Lake, New Jersey. However, there can be underlying medical conditions causing hypotension, so the documentation should state the medical problem. If the documentation states the specific type of hypotension, then the appropriate specific ICD-10-CM code should be used. Some of these include the following:

  • I95.0 (Idiopathic hypotension)
  • I95.1 (Orthostatic hypotension)
  • I95.2 (Hypotension due to drugs)
  • I95.3 (Hypotension of hemodialysis)
  • I95.81 (Postprocedural hypotension)
  • I95.89 (Other hypotension). This code also includes chronic hypotension.

You should always code the correct diagnosis that is documented, Brink says. It is important to educate providers that there are more specific ICD-10-CM codes for hypotension other than the unspecified code I95.9 and that those codes should be documented as the specific diagnosis rather than “unspecified.”

It is also important to remind providers that the diagnosis made at the patient encounter should be documented to support the medical necessity of performing the service rendered, according to Brink. If the diagnosis is specific for the medical problem, the appropriate ICD-10-CM code should be coded. If the diagnosis is “nonspecific,” the appropriate diagnosis should be coded. Always code from the provider’s documentation.

Rely on I95.1 for Orthostatic Hypotension

A common type of hypotension is orthostatic hypotension. You may also see orthostatic hypotension written in the documentation as postural hypotension.

With orthostatic hypotension, the patient’s blood pressure drops when they go from sitting to standing. This reading is in comparison to the patient’s blood pressure while sitting.

ICD-10-CM: Report I95.1 (Orthostatic hypotension) for orthostatic hypotension, Brink says.

Documentation tip: Check the medical record carefully to make sure your cardiologist specifically documented orthostatic hypotension, along with the patient’s vitals.

Symptoms: Symptoms of orthostatic hypotension include dizziness or lightheadedness when standing, fatigue, blurred vision, confusion, and nausea.

Mark Down Dx for Postprocedural Hypotension

Patients may experience postprocedural hypotension after they come out of anesthesia on the day of surgery or in the first days after surgery.

Causes of postprocedural hypotension include infections, fever, respiratory distress, reactions from anesthesia, or hypovolemia.

ICD-10-CM: Report I95.81 (Postprocedural hypotension) for postprocedural hypotension

Do This If Patient Has Idiopathic Hypotension

A patient is usually given the diagnosis of idiopathic hypotension when the underlying condition causing the hypotension is unknown. Idiopathic hypotension can either be temporary or chronic.

Idiopathic hypotension can be categorized as primary or secondary neurogenic or non-neurogenic.

ICD-10-CM: Report I95.0 (Idiopathic hypotension) for idiopathic hypotension.

Pinpoint Correct Hypotension of Hemodialysis Option

Dialysis-induced hypotension (DIH) is a common complication of renal replacement therapy.

ICD-10-CM: Report I95.3 (Hypotension of hemodialysis) for hypotension of hemodialysis. This code also includes intra-dialytic hypotension.

Understand How to Report Drug Induced Hypotension

With drug-induced hypotension, the patient experiences hypotension due to a medicine or chemical substance.

ICD-10-CM: Report I95.2 (Hypotension due to drugs) for hypotension due to drugs. This code also includes orthostatic hypotension due to drugs.

Don’t miss: You should use an additional code for adverse if applicable to identify the drug from categories T36- (Poisoning by, adverse effect of and underdosing of systemic antibiotics) through T50- (Poisoning by, adverse effect of and underdosing of diuretics and other and unspecified drugs, medicaments and biological substances).