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Taking a poll, what would you do?

  1. Smile Taking a poll, what would you do?
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    Ok this is reference to the hypertension codes: Malignant 403.00/403.01 versus Benign hypertension 403.10/403.11

    A new office visit with a patient that has a history of malignant hypertension. Would you bill for malignant hypertension if the patient only had a blood pressure of 160/100 and no other active symptoms during the course of this visit? Or would you bill for a benign hypertension code and have the physician state that the blood pressure is uncontrolled?

    I can so hardly wait for ICD-10 when this will not matter whether it's benign or malignant...

    Malignant hypertension definition: A person with malignant hypertension has a life threatening increase in blood pressure, which causes damage to blood vessels in the brain, eyes, heart, and kidneys. In someone with malignant hypertension, the systolic blood pressure (top number) is usually over 220, or the diastolic blood pressure (bottom number) is over 115. Malignant hypertension requires immediate treatment, in order to stop ongoing damage to the brain, heart, kidneys, or eyes.

    Benign hypertension definition: mild to moderate hypertension. It may be progressing at a very slow pace, and so any damage being caused may take many years to develop.

    Thank you!

    052274

  2. #2
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    we cannot code form knowing what the different hypertension definitions are, we can go only from the documentation, so if it just states hypertension even though there is a history of malignant hypertension mentioned I would go for the 401.9. You have specified the 403 so I am assuming then the patient has a chronic kidney disease also? so you need then the 403.9x with the 585.x code for the stage of chronic kidney disease

    Debra A. Mitchell, MSPH, CPC-H

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    Quote Originally Posted by mitchellde View Post
    we cannot code form knowing what the different hypertension definitions are, we can go only from the documentation, so if it just states hypertension even though there is a history of malignant hypertension mentioned I would go for the 401.9. You have specified the 403 so I am assuming then the patient has a chronic kidney disease also? so you need then the 403.9x with the 585.x code for the stage of chronic kidney disease
    Hi Debra,

    Thank you for responding. The reason I did not post the whole note is because the patient during the time of the visit was asymptomatic apart from the elevated blood pressure reading. The patient is on Ace inhibitors that treat malignant hypertension, but the patient at the time of visit was not malignant hypertensive. You are correct, the patient also has chronic kidney disease. Thank you so much for your input...

    Anyone else?

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    I agree. Maybe you should consider using ICD-9 V58.6x to help describe why the hypertension is under control.

  5. #5
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    Quote Originally Posted by 021402 View Post
    Ok this is reference to the hypertension codes: Malignant 403.00/403.01 versus Benign hypertension 403.10/403.11

    A new office visit with a patient that has a history of malignant hypertension. Would you bill for malignant hypertension if the patient only had a blood pressure of 160/100 and no other active symptoms during the course of this visit? Or would you bill for a benign hypertension code and have the physician state that the blood pressure is uncontrolled?

    I can so hardly wait for ICD-10 when this will not matter whether it's benign or malignant...

    Malignant hypertension definition: A person with malignant hypertension has a life threatening increase in blood pressure, which causes damage to blood vessels in the brain, eyes, heart, and kidneys. In someone with malignant hypertension, the systolic blood pressure (top number) is usually over 220, or the diastolic blood pressure (bottom number) is over 115. Malignant hypertension requires immediate treatment, in order to stop ongoing damage to the brain, heart, kidneys, or eyes.

    Benign hypertension definition: mild to moderate hypertension. It may be progressing at a very slow pace, and so any damage being caused may take many years to develop.

    Thank you!

    052274
    Even though you may know the parameters of malignant vs benign hypertension, you as a coder cannot assign that designation to a patient. The physician needs to state in the note whether the hypertension is malignant or benign. So in a case like this, I would go back to the provider and ask for clarification and get the proper documentation for the type of hypertension, before coding. If you cannot get clarification, then you must default to the unspecified benign hypertension code 401.9, to avoid giving the patient a condition they may not have.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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    Quote Originally Posted by ajs View Post
    Even though you may know the parameters of malignant vs benign hypertension, you as a coder cannot assign that designation to a patient. The physician needs to state in the note whether the hypertension is malignant or benign. So in a case like this, I would go back to the provider and ask for clarification and get the proper documentation for the type of hypertension, before coding. If you cannot get clarification, then you must default to the unspecified benign hypertension code 401.9, to avoid giving the patient a condition they may not have.
    Hi Arlene,

    Thank you so much for your input. This will help tremendously in regards to physician documentation and education! Have a great day!

    052274

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