ICD-9 2012: Perfect your HTN Coding

ICD-9 2012 codes go into effect on October 1 this year. Like other practices, your cardiology practice too will be impacted by this year's list of ICD-9 codes. And since Hypertension (HTN) is on the rise in the US, it's essential that your HTN coding is top-quality. Or else many of your claims will be in the danger zone.

Here are some rules to polish your HTN coding to perfection:

Utilize the Hypertension Table: This Hypertension Table simplifies your search and can be found under the ICD-9 index entry "Hypertension". It not only shows the basic 401.x (Essential hypertension) codes but also the codes for conditions owing to or associated with HTN. What's more, the table helps clarify when you code choices differ for malignant, benign or unspecified conditions.

Documentation & 401.x 4th Digit

Be it malignant (.0), benign (.1), or unspecified (.9), while reporting codes from 401.x, you must select a fourth digit to complete the code. You shouldn't use either 0 malignant or .1 benign unless medical record documentation supports such a designation.

'Hypertensive' aids 402.x Use

If a patient has both heart disease and HTN, knowing whether the HTN caused the heart condition is key to correct coding. See whether the patient has a condition described under heart disease codes 425.8, 429.0-429.3, 429.8, and 429.9. What's more, you should also check the documentation for a stated or implied causal relationship to HTN.

Think that HTN and chronic kidney disease are connected

ICD-9 codes presume a causal relationship between HTN and chronic kidney disease. If documentation shows a patient ahs HTN and a condition that falls under 585.x or 587, then you should report a code from 403.x even if there is no indication one lead to the other. You should also report the pertinent 585.x code to indicate the CKD stage.

Hypertensive Heart and CKD

A single code from 404.xx indicates the patient has both hypertensive heart disease and hypertensive CKD. You should once again assume a relationship between the HTN and CKD. When the patient suffers from hypertensive heart disease and CKD, you should select a code from 404.xx and not report 402.x (hypertensive heart disease) and 403.x (hypertensive CKD) together.

Head Diagnoses? Think 2 Codes

If the patient is diagnosed with hypertensive cerebrovascular disease, you should first go for the proper code from 430-438.x first and then report the proper hypertension code, 401.x-405.x.