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Basic information on Hypertension ICD-10 CM code

If you read the title, this will be the most common and confused coding scenario for medical coders. If you are fresher you will know Hypertension ICD 10 code but you will surely have lot of questions on when to code hypertension with heart disease, hypertension with kidney disease and when to code all of them together. Since these diseases are very closely linked with each other, we will be having problem for coding them. In Medical coding certification exam like CPC, there are questions from these topics and it is very important to know how to code such conditions. Now, let us learn how to deal with these scenarios and clear your confusions.

Hypertension Contributing factors:
• Family history of hypertension
• Age
• Race
• Smoking
• Overweight or obese
• Consumption of a high salt diet
• Stress
• Excess alcohol consumption

Coding Hypertensive or due to Heart disease

Before coding related Heart disease with hypertension, first we will just have a short look of the codes associated with hypertension.

Hypertension Associated ICD-10-CM codes:
H35.03 – Hypertensive Retinopathy – laterality
I10 – Hypertension
I11 – I11.9 – Hypertensive Heart Disease
I12 – I12.9 – Hypertensive Chronic Kidney Disease
I13 – I13.2 – Hypertensive Heart and Chronic Kidney Disease
I15 – I15.9 – Secondary Hypertension
I27 – I27.9 – Pulmonary Hypertension
I60 – I69 – Cerebrovascular Diseases
O10 – O11.9 – Pre-existing Hypertension
O13 – O16.9 – Pre-existing Hypertension with pre-eclampsia
P29 – Cardiovascular disorders originating in the perinatal period

From 2017, the ICD 10 coding guidlines has allowed to code Hypertension and Heart disease together. Earlier we have to look for any causal relationship between Hypertension and heart disease, but with updated guidelines in 2017, you don’t have to look for any causal relationship. Unless and until the physician documents that hypertension and heart diseases are unrelated, you can assume a causal relationship between them.

Hence, going forward don’t look for “hypertensive” or “due to” phrases to find a relationship between them. Just assume and code the combination code once you find both hypertension and heart disease documented in the report. If provider documents clearly that they are not related to each other, then only we have to code them separately. So as per ICD 10 coding guidelines, you can assume a relationship between a Hypertension (I10) and Heart disease. In short just check below when we will use combination code

Hypertension and/or Heart disease – Use a combination code (I11) followed by the type of Heart disease (I50 category)

Hypertensive or due to Heart disease – Use a combination code (I11) followed by the type of Heart disease (I50 category)

When clearly documented as unrelated – Code Separately hypertension (I10) and Heart Disease

Hope this will clear your doubt about coding hypertension and heart disease.

ICD 10 codes for Hypertensive Heart Disease

We have separate ICD 10 code for Essential or primary Hypertension, I10 which includes high blood pressure, arterial, benign, malignant, systemic. For coding hypertensive heart disease we have to use below list of ICD o codes for I11 series.

I11 Hypertensive heart disease

I11.0 Hypertensive heart disease with heart failure

Hypertensive heart failure

Use additional code to identify type of heart failure (I50.-)

We have to use type of heart failure along with I11.0 ICD 10 code as a secondary code. Below are the list of heart failure codes should be used along with I11.o code.

I50.1, Left ventricular failure,
I50.2, Systolic (congestive) heart failure,
I50.3, Diastolic (congestive) heart failure,
I50.4, Combined systolic and diastolic heart failure,
I50.9, Heart failure, unspecified.The three codes for systolic, diastolic, and combined failure also require a fifth digit specifying the acuity of the diagnosis:
- 0, Unspecified,
- 1, Acute,
- 2, Chronic,
- 3, Acute on chronic.

I11.9 Hypertensive heart disease without heart failure

Hypertensive heart disease NOS

Coding Hypertension and/with Chronic Kidney Disease (CKD)

As per the updated coding guidelines , if there is mention of hypertension and Chronic kidney disease, you can assume a causal relationship between them. Like hypertension and heart disease you can assume a relationship between CKD and hypertension as well. We can go ahead and use combination code for hypertension and Kidney disease irrespective of And or With. The simple rule here we have to use a combination code if there is documentation of hypertension and Chronic Renal Disease anywhere in the medical report.

Do remember if the provider documents that both hypertension and Chronic kidney disease are unrelated, we have to code them separately.

Hypertension and/with Chronic kidney disease – use a Combination code (I12) for hypertension and Chronic kidney disease followed by the type or stage of Chronic kidney disease.

ICD 10 codes for Hypertension Chronic kidney disease

ICD 10 code category, I12 represent the Hypertensive chronic kidney disease.

I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease

We have to use additional code to identify the stage of chronic kidney disease (N18.5,N18.6)

I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease.

This code should be used for hypertensive chronic kidney disease, hypertensive renal disease. We should also use a secondary ICD 10 code to specify the stage of CKD (N18.1-N18.4, N18.9)

Below are the ICD 10 codes for different stages of Chronic kidney disease.

N18.1, Chronic kidney disease, stage 1,
N18.2, Chronic kidney disease, stage 2 (mild),
N18.3, Chronic kidney disease, stage 3 (moderate),
N18.4, Chronic kidney disease, stage 4 (severe),
N18.5, Chronic kidney disease, stage 5,
N18.6, End-stage renal disease,
N18.9, Chronic kidney disease, unspecified.

For patients with end-stage renal disease, code Z99.2, Dependence on renal dialysis, should be assigned as an additional code to report dialysis status.

If the patient with Chronic Kidney disease, stage 5 requires a chronic dialysis, can be coded as ESRD (N18.6) only since patient with ERSD regular dialysis sessions or kidney transplant to continue normal life of patient. Z99.2 or Z94.0 should be used as secondary diagnosis for renal dialysis or transplant with ESRD depending on the documentation.

ICD 10 codes for Hypertension, Heart and Kidney Disease

I10 – Hypertension

I11 – Hypertensive Heart Disease

I12 – Hypertensive Chronic kidney Disease

I13 – Hypertensive Heart and Chronic kidney disease

I15 – Secondary Hypertension

Coding for Hypertension kidney Heart Disease

Now, after going through this article you should be easily code Hypertension kidney heart disease. Here, we have to completely follow the ICD 10 coding guidelines. If the documentation support all the three condition i.e. hypertensive heart kidney disease, we will go ahead and code a combination code from I13 category for hypertensive heart kidney disease. If the provider documents their is no relationship between hypertension and heart disease or renal disease we can code it separately for Hypertension I10 and Heart disease/renal disease category. The simple rule here is just follow the ICD coding guidelines and it will easy for you to select the appropriate diagnosis codes.

For patients with both acute renal failure and chronic kidney disease, an additional code for acute renal failure is required.

ICD 10 codes for Hypertensive heart and chronic kidney disease w/wo heart failure

I13 Hypertensive heart and chronic kidney disease

I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease

code additional code for the type of heart failure (I50.-) and stage of CKD

I13.1 Hypertensive heart and chronic kidney disease without heart failure

I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease

use additional code for the stage of CKD.

I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease

code additional code for the type of heart failure (I50.-) and stage of CKD

Difference between Elevated blood pressure and Hypertension

Blood pressure reading varies from the time to time with the age. When their is constant reading of elevated blood pressure on different days and time, it may be considered as hypertension. When only due to sudden acute increase of blood pressure, we cannot considered as the hypertension diagnosis.

Hence, the medical coders do not assign hypertension code I10 on the basis of readings given in the document. The physician must specifically document the word “hypertension” to code it as I10 as confirmed diagnosis.

For temporary increase of elevated blood pressure can only be coded as R03.0 diagnosis code. Do not get confused between I10 and R03.0 codes.

An acute phase of elevated blood pressure should be coded as R03.0 and chronic phase of elevated blood pressure should be reported with I10 but should be supported with physician documentation as “Hypertension”.

Also, pulmonary hypertension has specifically relates to pulmonary arteries. When the blood pressure increase in pulmonary arteries, the coders need to assign pulmonary hypertension I27.20 diagnosis codes. Since this hypertension occurs due to other condition, it is called as secondary pulmonary hypertension.

When to medical coder comes across the Eisenmenger syndrome (ICD10 code- I27.83), in which blood vessels of lung become narrow and the blood pressure rises in arteries of lung. If this syndrome is present, then I27.2 series codes of pulmonary hypertension gets included in this syndrome code (I27.83). You can also see in the Excludes 1 notes which shows I27.2 and I27.83 should not coded together.

Additional ICD 1o codes for Hypertension

I15 Secondary hypertension

I15.0 Renovascular hypertension

I15.1 Hypertension secondary to other renal disorders

I15.2 Hypertension secondary to endocrine disorders

I15.8 Other secondary hypertension

I15.9 Secondary hypertension, unspecified

ICD-10 is required for use by physicians and healthcare providers under the Health Insurance Portability & Accountability Act (HIPAA).

Hope, you would have got some useful tips for Hypertension ICD 10 coding and combination code for hypertension, heart disease and renal disease. Do share it if you find it helpful.

Hypertension ICD-10 CM Coding Guide for Coders