HYPERTENSION Definition Change
In ICD-10, hypertension is defined as essential (primary). The concept of “benign or malignant” as it relates to hypertension no longer exists.
When documenting hypertension, include the following:
1. Type e.g. essential, secondary, etc.
2. Causal relationship e.g. Renal, pulmonary, etc.
I10 Essential (primary) hypertension
I11.9 Hypertensive heart disease without heart failure
I15.0 Renovascular hypertension
When documenting hypertension, include the following:
1. Timeframe An AMI is now considered “acute” for 4 weeks from the time of the incident, a revised timeframe from the current ICD-9 period of 8 weeks.
2. Episode of care ICD-10 does not capture episode of care (e.g. initial, subsequent, sequelae).
3. Subsequent AMI ICD-10 allows coding of a new MI that occurs during the 4 week “acute period” of the original AMI.
ICD 9 code for Hypertension 401
401.9 – Essential hypertension; unspecified Toggle Dictionary Definitions
401 Includes: high blood pressure, hyperpiesia, hyperpiesis, arterial hypertension, essential hypertension, primary hypertension, systemic hypertension
hypertensive vascular: degeneration, disease
Excludes: elevated blood pressure without diagnosis of hypertension (796.2), pulmonary hypertension (416.0-416.9), that involving vessels of: brain (430-438), eye (362.11)
401-405
Excludes: that complicating pregnancy, childbirth, or the puerperium (642.0-642.9)
that involving coronary vessels (410.00-414.9)
ICD-9 Description ICD-9 ICD-10 Description ICD-10
401.9 Unspecified essential hypertension I10 Essential (primary) hypertension
401.1 Benign essential hypertension I10 Essential (primary) hypertension
Diverse facts about hypertension
Human body is the one of the complicated creation and can be called as best engineering that they world has ever seen. Human body is a combination of bones, muscles, nerves and organs with the blood flow all over the body. After extensive medical research the functions of the body and also each change that happens in the body are termed accordingly. The increase in the blood pressure is called as hypertension which is an issue that should be considered seriously. It will cause various inconveniences in the body and will bring pain and other problems. Blood is pumped all over the body in the by the heart as it pumps the purified the blood to pass to the entire body.
The pressure reading of the blood in the body makes huge influence in the body and hence there should be proper level of blood pressure. The top level of blood pressure is called as systolic and the lower level is called diastolic. The systolic level is reached when the heart pumps the blood out to flow all through the body. Hypertension occurs when they blood pressure level reached above 140. This should be taken in serious note because there would be many complications and health issues. Hypertension is risky as it causes sickness such as heart disease, kidney disease, stroke, and heart attacks. Most of the cardio vascular diseases are because of the high blood pressure.
It increases the stress in the heart as the heart strains much for the need for oxygen as the systole level is reached. Basically there some reasons for high blood pressure and that includes: stress, imbalanced diet, environmental factors, smoking, and moreover genetic problems. The increase in the salt content in the human body will increase the blood pressure in the body. The other causes for high blood pressure are because the obesity and overweight and also the increasing water content and hormonal changes in the body. Therefore it is advised to diagnose high blood pressure in the early stage to take proper treatment to avoid the risk.
Early treatment will reduce the risk of kidney problems and heart attacks. Treatment will be given according to the type of high blood pressure the person is suffering from. The major two types of high blood pressure are primary and secondary. The most of the people who suffering from hypertension will have primary type and the rest of the people will have the secondary type. Only below ten percentages of patients will have secondary type but both the types are risky.
The cause for the primary type is not known exactly as it can be anything and the cause for the secondary type is combination of the reasons discussed above. If the repercussions are mild the medications will be given to regulate the pressure levels and for the issues happened to the person whereas if the repercussions are high then they will give treatment for the organs affected by high blood pressure. Take necessary steps earlier to get rid of the risk.
CONGESTIVE HEART FAILURE CHF ICD code
Terminology Differences & Increased Specificity
The terminology used in ICD-10 exactly matches the types of CHF. If you document “decompensation” or “exacerbation,” the CHF type will be coded as “acute on chronic.”
When documenting CHF, include the following:
1. Cause e.g. Acute, chronic
2. Severity e.g. Systolic, diastolic
I50.23 Acute on chronic systolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
Congestive Heart Failure is a chronic complex clinical syndrome which prevents filling or emptying of blood from the heart. CHF is caused by either a structural (valvular or congenital) and/or a dysfunctional (myocardial infarction) anomaly. The most frequently observed clinical manifestations include shortness of breath, edema and weight gain. Of those that are diagnosed about half of the patients will die within five years from their initial date of diagnosis.
The heart’s function is measured based upon a percentage, also known as the ejection fraction (EF). The EF is defined as the fraction of blood that is pumped out of the heart with each heartbeat from the left side of the heart. The EF plays a primary role in the diagnosis of CHF. A normal EF is classified as above 50%. Imaging studies such as an echocardiogram, cardiac MRI or a nuclear cardiac scan can estimate the EF.
Generally, the evaluation of CHF includes:
• History intake – paying particular attention to the risk factors of the disease
• Physical examination
• Objective data such as: chest film, echocardiogram, cardiac MRI and lab work – namely a Brain Naturetic Peptide (BNP).
The severity of CHF is classified through clinical symptoms along with the New York Heart Association (NYHA) classification system:
• Class I – Symptoms of CHF only at activity levels that would limit normal individuals
• Class II – Symptoms of CHF with ordinary exertion
• Class III – Symptoms of CHF with less than ordinary exertion
• Class IV – Symptoms of CHF at rest.
HFpEF = CHF with preserved EF
HFrEF = CHF with reduced EF
GDMT = Guideline determined medical therapy
HRQOL = Health related quality of life
MCS = Mechanical circulatory support
AF = Atrial fibrillation
The diagnosis of CHF is progressive, which requires chronic disease management. The stages of disease progression are as follows:
• Stage A – At high risk for CHF but without structural heart disease or symptoms of CHF
• Stage B – Structural heart disease but without signs or symptoms of CHF
• Stage C – Structural heart disease with prior or current symptoms of CHF
• Stage D – Refractory CHF requiring specialized interventions.
The therapeutic options for CHF include medication and device interventions. Medications such as beta blockers, Angiotensin converting enzyme inhibitors (ACE i), Angiotensin receptor blockers (ARB’s), diuretics are used in both diastolic and systolic heart failure patients. Device interventions such as cardiac resynchronization therapy (CRT) and implantable cardiac defibrillators (ICD) are used to either improve CHF symptoms or prevent sudden cardiac death.
From a wellness standpoint, patients with CHF should be re-evaluated every 30 to 90 days. At every visit, the patient should be:
CONGESTIVE HEART FAILURE
Terminology Differences & Increased Specificity
The terminology used in ICD-10 exactly matches the types of CHF. If you document “decompensation” or “exacerbation,” the CHF type will be coded as “acute on chronic.”
When documenting CHF, include the following:
1. Cause e.g. Acute, chronic
2. Severity e.g. Systolic, diastolic
ICD-10 Code Examples
I50.23 Acute on chronic systolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
Documentation and coding tips
• Provide clear and concise documentation
• Describe the type of CHF as systolic and/or diastolic
• Anatomically relate the CHF as left or right side
• Note the stability of the CHF presentation as being acute or chronic
• If known, link CHF to other associated conditions, i.e.Hypertension (HTN) & Chronic Kidney Disease (CKD)
• When making a diagnosis, also provide a treatment plan
• Remember that CHF is a targeted, monitored outcome for the Hospital Readmission Reduction Program as part of the Affordable Care Act
• For CHF there was no change in the code specificity from I9 to I10
• Consider with every clinical encounter:
• Verify patient name and date of birth
• Include date of service
• Include provider name, credentials and signature
• A (-) dash is used instead of (x), which indicates the need for additional code characters
• Non-specific codes will be rejected in claims
• There is no need to code hypertension as malignant, benign, or unspecified
• Use additional codes to identify stage of CKD.
• Heart disease must be linked to HTN by use of linkage terms such as: CHF secondary to HTN
428.0 Congestive heart failure, unspecified ICD 9 code can be replaced by
I50.20 Unspecified systolic (congestive) heart failure
I50.21 Acute systolic (congestive) heart failure
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.30 Unspecified diastolic (congestive) heart failure
I50.31 Acute diastolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.9 Heart failure, unspecified
402.01 Hypertensive heart disease, malignant, with heart failure MAL HYPERT HRT DIS W HF
402.11 Hypertensive heart disease, benign, with heart failure BENIGN HYP HT DIS W HF
402.91 Hypertensive heart disease, unspecified, with heart failure HYP HT DIS NOS W HT FAIL
404.01 Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified MAL HYP HT/KD I-IV W HF
404.03 Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease MAL HYP HT/KD STG V W H
404.11 Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified BEN HYP HT/KD I-IV W HF
404.13 Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease BEN HYP HT/KD STG V W HF
404.91 Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified HYP HT/KD NOS I-IV W HF
404.93 Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease HYP HT/KD NOS ST V W HF
428.0 Congestive heart failure, unspecified CHF NOS
428.1 Left heart failure LEFT HEART FAILURE
428.20 Unspecified systolic heart failure SYSTOLIC HRT FAILURE NOS
428.21 Acute systolic heart failure AC SYSTOLIC HRT FAILURE
428.22 Chronic systolic heart failure CHR SYSTOLIC HRT FAILURE
428.23 Acute on chronic systolic heart failure AC ON CHR SYST HRT FAIL
428.30 Unspecified diastolic heart failure DIASTOLC HRT FAILURE NOS
428.31 Acute diastolic heart failure AC DIASTOLIC HRT FAILURE
428.32 Chronic diastolic heart failure CHR DIASTOLIC HRT FAIL
428.33 Acute on chronic diastolic heart failure AC ON CHR DIAST HRT FAIL
428.40 Unspecified combined systolic and diastolic heart failure SYST/DIAST HRT FAIL NOS
428.41 Acute combined systolic and diastolic heart failure AC SYST/DIASTOL HRT FAIL
428.42 Chronic combined systolic and diastolic heart failure CHR SYST/DIASTL HRT FAIL
428.43 Acute on chronic combined systolic and diastolic heart failure
AC/CHR SYST/DIA HRT FAIL
428.9 Heart failure, unspecified HEART FAILURE NOS
