Be sure to assign I11.0 (Hypertensive heart disease with heart failure), not I10 (Essential (primary) hypertension), for a patient’s hypertension when that patient also has heart failure and the physician hasn’t specified another cause for the heart failure, or risk an ADR.
This is based on the presence of an assumed relationship between hypertension and heart disease, including heart failure, when the patient has both diagnoses and no other etiology is identified, according to FY2017 official coding guidelines and the alphabetic index[I.C.9.a]
The guideline update represents a complete turnaround from previous guidance which held that the physician must link a patient’s hypertension and heart disease/heart failure before they can be coded as connected. [CPH, 10/16]
As a result of this change, some coders are still struggling to get comfortable with the idea that the hypertension and heart disease/heart failure assumption is now the accepted practice. They’re asking, “can I really just assume it now?” says Judy Adams, HCS-D, president of Adams Home Care Consulting in Durham, N.C.
But not heeding the new guidance can cost you: In at least one case, an ADR resulted from a coder’s mistaken assignment of I10 with a code from I50.- (Heart failure), says Vonnie Blevins, HCS-D, the coding and billing manager at Excellence Healthcare in Houston.
Jun 29, 2018
Diagnosis Coding
AHCC Insider -August 2017