Relax and learn the basics for coding hypertension
Hypertension is a frequent diagnosis coded in home health and hospice, so it is essential to code it correctly.
Providers use many terms such as “uncontrolled blood pressure,” “systemic blood pressure,” or “stable blood pressure.” All of these are coded as essential hypertension. Arterial, malignant, benign, and unspecified are considered nonessential modifiers for hypertension.
It’s a fine line
High blood pressure, though widespread, is not an innocuous diagnosis. You must make sure the provider states the patient has a diagnosis of hypertension. Some patients will exhibit a transient rise in their pressure readings due to stress, pain, or other external factors.
Often the provider denotes “borderline hypertension.” This is not true hypertension, and you code it to R03.0.
I10 essential hypertension
Essential hypertension (I10) is primary hypertension with no other known organ development.
Two conditions are presumed to have a causal relationship with essential hypertension, as found in the Alphabetic Index. They are linked by the word “with.”
These are kidney and heart involvement, and you code them as related unless the provider clearly states the conditions are unrelated. At times these two conditions are both involved.
These are the associated codes and notes:
- I11.0 (Hypertensive heart disease with heart failure) — Use additional code to identify type of heart failure (I50)
- I11.9 (Hypertensive heart disease without heart failure)
- I12 (Hypertensive chronic kidney disease) — Use additional code to identify the stage of chronic kidney disease (N18) - use .9 if stage I-IV and .0 for stage V or VI ESRD
- I13 (Hypertensive heart and chronic kidney disease) — Fourth and fifth character choices within the I13 category will indicate the presence or absence of heart failure, as well as the presence of end stage renal disease. — Use an additional code to identify type of heart failure (I50) and Use an additional code to identify the stage of chronic kidney disease (N18.1-N18.4, N18.6, or N18.9).
Other hypertension codes
Here’s a quick rundown of other hypertension codes. Be sure the provider has thoroughly documented the diagnoses to support each code’s use.
- Pulmonary Hypertension (I27.-)
- Complication of pregnancy and childbirth (O10 to O16)
- Portal Hypertension (K76.6)
- Secondary Hypertension (I15. --)
- Renovascular hypertension (I15.0)
- Hypertensive crisis (I16) This is a true emergent situation and is not treated or coded in the home health setting.