Medical Billing and coding for hypertension claims is easy if you follow these five basic rules of ICD-9. ICD-9 codes are updated every year. And with these updates, codes are becoming more comprehensive as payers steer away from unspecified code sets. Hypertension, a disease that according to the Centers for Disease Control and Prevention (CDC) affects thirty-three percent of adults over the age of twenty, has seen its coding become increasingly reliant upon the information found in patients’ medical records. This means if your HTN coding is not first-rate, your practice could be losing revenue on every claim! In order to keep your coding compliant with ICD-9, as well as to receive full compensation, you should apply these five rules based on the ICD-9 official guidelines.
Rule #1: Use the Hypertension Table in ICD-9
The Hypertension Table provides not only the basic 401.x (essential hypertension) codes, but also provides the codes for conditions associated with hypertension, while distinguishing code options for malignant, benign, and unspecified conditions.
Rule #2: Don’t Forget the 4th Digit!
You must choose a 4th digit when coding a 401.x! Remember, documentation in the medical record is necessary to remain compliant so, even though benign hypertension is far more common than malignant hypertension, do not assume your 4th digit code! The following is a breakdown of how to accurately complete your 401.x code set: malignant (.0), benign (.1), unspecified (.9).
Rule #3: Hypertension and Chronic Kidney Disease: Together or Separate?
When a patient has both hypertension heart disease (HTN) and hypertensive chronic kidney disease (CKD), you should use a single code, a 404.xx! You should not report a 402.x (Hypertensive Supports) and a 403.x (hypertensive CKD).
If medical records indicate a patient has hypertension heart disease AND a chronic renal failure (585.x) OR renal sclerosis unspecified (587), then you should code for hypertensive renal disease (403.x), even if documentation doesn’t indication one caused the other.
Rule #4: Head Diagnoses – Keep them Separate!
Not all hypertensive diseases have combination codes! When a patient is diagnosed with hypertensive cerebrovascular disease (430-438.x) or hypertensive retinopathy (362.11), you should code these first and then report the correct hypertension codes (401.x – 405.x).
Rule #5: Use 405.x When an Underlying Condition Causes HTN
When medical records show that an underlying condition caused a patient’s HTN, then their HTN becomes known as secondary HTN. In order to properly code, first report the code for the underlying condition and then use a 405.x (secondary hypertension) to report the HTN.
By Scott Shatzman
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