Cardiology Coding Alert

Reader Question:

Make Sure to Sequence ICD-10 Codes Correctly

Question: The cardiologist documents a diagnosis of left ventricular failure caused by hypertension. What ICD-10 codes should we report?

Alaska Subscriber

Answer: Since hypertension is the cause of the heart failure, you would report I11.0 (Hypertensive heart disease with heart failure). However, the note for I11.0 indicates you must report an additional code from the I50 series “to identify the type of heart failure,” which, in this case, would be I50.1 (Left ventricular failure, unspecified). And all the I50 codes come with a code first note that states I50.1 must always be reported after I11.0, when appropriate.

Remember: Code first notes indicate the primary reason for the diagnosis. They indicate the main cause for this other diagnosis.

The code first note, then, says that this disease or illness has caused this other disease or illness. So, you would report I11.0 before I50.1 if hypertension was the cause of the heart failure.

Reminder:  There is a presumed causal relationship between hypertension and heart involvement (I50.- and I51.4-I51.9) and between hypertension and kidney involvement, as the two conditions are linked by the term “with” in the ICD-10 Alphabetic Index. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states that the conditions are unrelated.