Home Health ICD-9/ICD-10 Alert

Published on Fri Nov 26, 2004 PDF

Question: Which code should we use to show the diagnosis of hypertension that is renal disease-related? We have been using 401.9 (Essential hypertension; unspecified). 

Answer: You may run into problems using an unspecified code for this type of hypertension. There is an extensive list of diagnosis codes for hypertension, and coding it as unspecified can lead to a denial.
 
To code hypertensive renal disease, assign codes from category 403.x (Hypertensive renal disease) when conditions classified to categories 585-587  - Renal failure and renal sclerosis - are present, according to the American Hospital Association's Coding Clinic, Fourth Quarter, 2002. The Coding Clinic also states, "Do not use either .0 malignant or .1 benign unless medical record documentation supports such a designation."
 
Unlike hypertension with heart disease, ICD-9 presumes a cause-and-effect relationship and classifies renal failure with hypertension as hypertensive renal disease.
 
When both hypertensive renal disease and hypertensive heart disease are stated in the diagnosis, assign codes from combination category 404.xx (Hypertensive heart and renal disease).
 
Assume a relationship between the hypertension and the renal disease, regardless of whether the condition is so designated.