Cardiology Coding Alert

Question: Is “white coat hypertension” a covered diagnosis? If so, what codes can we submit to report this diagnosis?

Nebraska Subscriber

Answer: The best diagnosis code for white coat hypertension is 796.2 (Elevated blood pressure reading without diagnosis of hypertension). Per ICD-9, you should use this code to record an episode of elevated blood pressure in a patient for whom the physician hasn’t made a formal diagnosis of hypertension or as an incidental finding. The ICD-9 index lists it under transient hypertension. The ICD-10 equivalent to 796.2 is R03.0 (Elevated blood pressure reading, without diagnosis of hypertension).

What is white coat hypertension? White coat hypertension is a condition where your physician records high blood pressure readings in the doctor’s office, but normal readings in other settings. 

Report ambulatory monitoring: Your physician will record ambulatory blood pressure monitoring (ABPM) for a minimum period of 24 hours to make a diagnosis of white coat hypertension. You choose from the following codes for the ABPM:

• 93784, Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report

• 93786, …recording only

• 93788, …scanning analysis with report

• 93790, …review with interpretation and report.

What Medicare says: In addition to supplying 796.2 for Medicare patients, you also have to prove that the patient meets Medicare’s criteria for white coat hypertension. According to Medicare Claims Processing Manual, Chapter 32, Section 10, a diagnosis of white coat hypertension should be suspected when a patient has all three of the following:

• Clinic/office blood pressure greater than140/90 mm Hg on at least three separate clinic/office visits with two separate measurements made at each visit

• At least two documented separate blood pressure measurements taken outside the clinic/office that are less than 140/90 mm Hg

• No evidence of end-organ damage.