Cardiology Coding Alert

Question:

Texas Subscriber

You should report both the hypertensive heart disease and hypertensive kidney disease using a single code from 404.xx (Hypertensive heart and chronic kidney disease).

ICD-9 guidelines state that you should "assume a relationship between the hypertension and the kidney disease, whether or not the condition is so designated."

Choose the fourth digit of your 404.xx code based on whether the documentation indicates the hypertensive disease is malignant (0) or benign (1). Or if the documentation doesn't indicate either of those, choose fourth digit 9 (unspecified).

You should base the fifth digit on the presence of heart failure and the stage of the chronic kidney disease. For example, note the definition of 404.03 (Hypertensive heart and chronic kidney disease; malignant; with heart failure and chronic kidney disease stage V or end stage renal disease).

Don't miss: If your documentation notes the type of heart failure, ICD-9 instructions state to use an additional code from 428.0-428.43 (Heart failure) to specify the type of heart failure. And notes following the 404.xx fifth-digit options instruct you to "use additional code to identify the stage of chronic kidney disease." You should choose that code from 585.x (Chronic kidney disease).