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Internal Medicine Coding Alert

Reader Questions:

Avoid Unspecified Diagnosis for Hypertension

Published on Tue Jul 01, 2003 Print Friendly and PDF PDF

Question: Which code should we use to show the diagnosis of hypertension that is renal-disease-related? We have used 401.9, and it is often denied.

Arizona Subscriber
 


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, hypertensive renal disease, when conditions classified to categories 585-587 (Renal failure and renal sclerosis) are present, according to Coding Clinic, 4th Quarter, 2002. 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.
 
The Coding Clinic also states, Do not use either .0 malignant or .1 benign unless medical record documentation supports such a designation. So, physician education on the need for complete documentation is key to avoiding future denials.

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