Cardiology Coding Alert

Question 2: According to the medical documentation, a patient who recently underwent dialysis developed hypotension because the patient’s autonomic nervous system is sensitive to volume changes and passed out. What ICD-10-CM code should I report on the claim?

Answer 2: This is an example of hypotension of hemodialysis so you should report I95.3 (Hypotension of hemodialysis). Code I95.3 also includes intra-dialytic hypotension.

Understand Orthostatic Hypotension

Question 3: What is orthostatic hypotension? What are some of the symptoms?

Answer 3: Orthostatic hypotension, also known as postural hypotension, relates to a drop in blood pressure when patients go from sitting to standing.

“Orthostatic hypotension happens when a person’s blood pressure drops significantly within three minutes upon standing, greater then 20mm Hg of mercury in a person’s systolic blood pressure, and/or more than 10mm of mercury in diastolic blood pressure,” according to Robin Peterson, CPC, CPMA, manager of professional coding, Pinnacle Integrated Coding Solutions, LLC.

The main symptom of orthostatic hypotension is the patient feeling dizzy or lightheaded when standing. Other symptoms include the fatigue, blurred vision, confusion, and nausea.

Turn to I95.1 for Orthostatic Hypotension

Question 4: What ICD-10-CM code should I report for orthostatic hypotension?

Answer 4: If your cardiologist documents orthostatic hypotension, you should report I95.1 (Orthostatic hypotension).

See Relationship Between Hypotension and Syncope

Question 5: Can orthostatic hypotension and syncope occur together?

Answer 5: Yes. Orthostatic hypotension and syncope can occur together. The evaluation for the syncope and hypotension depends on the findings from the history and physical examination (H&P), especially orthostatic blood pressure evaluation, auscultation of the carotid arteries, and the cardiac exam. Your cardiologist can perform a resting electrocardiogram (ECG) to determine if the patient has rhythm or conduction issues. Telemetry monitoring with a Holter monitor or an event recorder may also detect any abnormalities or arrhythmias.

Your cardiologist can diagnose orthostatic hypotension from an autonomic function by observing the patient’s blood pressure (BP) and heart rate response to tilt table testing.

Bottom line: Your cardiologist must determine where that hypotension and the syncope that can commonly be found with the hypotension originates from.

Patient Has Idiopathic Hypotension? Do This

Question 6: What ICD-10-CM code should I report for idiopathic hypotension?

Answer 6: You should report I95.0 (Idiopathic hypotension) for idiopathic hypotension.

“Idiopathic hypotension happens for numerous different reasons. It can be a temporary or chronic condition,” Peterson says. “In general, there are four categories this condition falls under: medication induced, primary or secondary neurogenic, and non-neurogenic. A patient is given the diagnosis of idiopathic hypotension when the underlying condition causing the hypotension is unknown.”

Don’t Forget to Include Additional Code

Question 7: What ICD-10-CM code should I report for hypotension due to drugs?

Answer 7: You should report I95.2 (Hypotension due to drugs) for hypotension due to drugs. Code I95.2 also includes orthostatic hypotension due to drugs.

Don’t miss: You should report an additional code for adverse effects, if applicable to identify the drug —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), according to ICD-10-CM.

Discover Correct Dx for Postprocedural Hypotension

Question 8: What is postprocedural hypotension and what ICD-10-CM code should I report for this condition?

Answer 8: “Postprocedural hypotension happens for various reasons including infections, fever, respiratory distress, reactions from anesthesia, or hypovolemia (blood loss),” according to Peterson.

You should report I95.81 (Postprocedural hypotension) for postprocedural hypotension.