How to Document and Code for Hypertensive Diseases in ICD-10

This installment in FPM's ICD-10 series explains the guidelines for coding hypertension.

Fam Pract Manag. 2014 Mar-Apr;21(2):5-nine.

Author disclosure: no relevant financial affiliations disclosed.

This content conforms to AAFP CME criteria. See FPM CME Quiz.

Article Sections

  • Introduction
  • Essential (primary) hypertension: I10
  • Hypertension and hypertensive centre affliction: I11
  • Hypertension and chronic kidney illness: I12
  • Hypertension, hypertensive heart disease, and chronic kidney disease: I13
  • Tobacco employ or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-10
  • References

Because ICD-10 tin can be a distressing topic, permit'south first with some good news: Hypertension has a limited number of ICD-10 codes – only 9 codes for primary hypertension and v codes for secondary hypertension. This makes the task of coding hypertension relatively simple – well, at least compared to some of the other ICD-10 complexities.

Another positive alter in ICD-ten is that the new code gear up drops the previous reference to benign and malignant hypertension. As physicians, we are well aware that hypertension is never truly "benign," and the removal of this antiquated term is a welcome comeback in the lexicon of diseases.

Just, of course, cipher is easy in ICD-x, and there are several things you need to be aware of earlier we dig into the codes themselves. For example, the hypertensive disease codes in ICD-10 exclude several conditions: hypertension complicating pregnancy, neonatal hypertension, primary pulmonary hypertension, and primary and secondary hypertension involving vessels of the brain or the heart. Postprocedural hypertension is also excluded from the secondary hypertension codes.

In addition, you'll need to be careful throughout the "Diseases of the Circulatory System" chapter of ICD-10 to differentiate the capital "I" from the number "1." The hypertension codes span from I10 to I15 (at that place is no I14), and each series has its own peculiarities, as this article volition explicate.

HYPERTENSIVE Illness ICD-10 CODES

This article contains several code lists and tables, which are available hither for download as a unmarried resource.

Download in PDF format

Essential (primary) hypertension: I10

  • Abstract
  • Essential (primary) hypertension: I10
  • Hypertension and hypertensive heart disease: I11
  • Hypertension and chronic kidney affliction: I12
  • Hypertension, hypertensive heart disease, and chronic kidney affliction: I13
  • Tobacco apply or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-10
  • References

In ICD-9, essential hypertension was coded using 401.0 (malignant), 401.1 (benign), or 401.9 (unspecified). ICD-ten uses simply a single code for individuals who run across criteria for hypertension and do not have comorbid heart or kidney disease. That code is I10, Essential (master) hypertension.

As in ICD-9, this lawmaking includes "high blood pressure" just does not include elevated claret pressure without a diagnosis of hypertension (that would be ICD-x lawmaking R03.0). If a patient has progressed from elevated blood pressure to a formal diagnosis of hypertension, a good documentation practice would exist to include the reason for progressing the formal diagnosis. Similarly, a unmarried mildly elevated blood pressure reading should exist coded with the R03.0 until the formal diagnosis is established.

Although various sources define hypertension slightly differently, the provider should document elevated systolic pressure above 140 or diastolic pressure above 90 with at least two readings on split function visits. There are slight variations of this for older individuals and for individuals with readings obtained through ambulatory blood pressure monitoring. From a documentation viewpoint, information technology is only important that the provider clearly document the basis for a newly established diagnosis.

Instance: Your patient, a 55-year-old female, has had blood force per unit area readings between 130–135/eighty–85 for several years. At her annual examination, y'all record her blood pressure as 144/92 and 142/90. You discuss with her the importance of following up and schedule another appointment for two weeks after. At that time, she again has several readings in a higher place 140/90, then you document the progression from prehypertension (R03.0) to essential hypertension (I10).

Hypertension and hypertensive center affliction: I11

  • Abstract
  • Essential (chief) hypertension: I10
  • Hypertension and hypertensive centre affliction: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive eye disease, and chronic kidney affliction: I13
  • Tobacco use or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-ten
  • References

When an private has hypertension and eye disease, it is up to the provider to determine whether there is a causal human relationship stated or unsaid. This relationship determination is spelled out in the "Official Guidelines for Coding and Reporting" (draft 2014).1

The combination of hypertension and hypertensive heart affliction is currently coded using the ICD-9 402.xx serial of codes. Every bit noted earlier, each category is currently divided into malignant, benign, and unspecified essential hypertension with or without heart failure. In ICD-10, this is narrowed to only two base codes:

  • I11.0, Hypertensive centre disease with center failure,

  • I11.nine, Hypertensive centre disease without center failure.

The ICD-10 manual does non list the required documentation for hypertensive heart illness. It is recommended, however, that the provider document the basis for the diagnosis (exam, electrocardiogram, echocardiogram, etc.) at least the starting time time this diagnosis is fabricated for the patient. Information technology is not uncommon for patients with long-standing hypertension to develop some cardiac changes, but to code I11.9 instead of just I10, the provider needs to document the support for doing and then.

Unlike ICD-ix, when yous lawmaking hypertension with heart failure (I11.0) using ICD-x, you are required to also lawmaking the type of heart failure from the I50 series:

  • I50.1, Left ventricular failure,

  • I50.ii, Systolic (congestive) center failure,

  • I50.3, Diastolic (congestive) centre failure,

  • I50.four, Combined systolic and diastolic center failure,

  • I50.9, Heart failure, unspecified.

If yous do not have a measurement of the left ventricular ejection fraction (typically from an echocardiogram), then y'all would need to utilise the more full general left ventricular failure code (I50.i).

The three codes for systolic, diastolic, and combined failure also require a fifth digit specifying the vigil of the diagnosis:

  • 0, Unspecified,

  • i, Astute,

  • two, Chronic,

  • 3, Acute on chronic.

Example: You have been following a 60-year-former male with hypertension and mild heart failure. You have coded I11.0 and I50.9. He recently had an astute exacerbation of his centre failure, was briefly hospitalized, and had an echocardiogram performed documenting combined systolic and diastolic failure. At discharge, yous update his diagnosis codes to I11.0 and I50.43. When you run into him in the part 2 weeks post-discharge and he is asymptomatic, his diagnosis codes could be I11.0 and I50.42 reflecting the chronic nature of his condition.

Hypertension and chronic kidney disease: I12

  • Abstract
  • Essential (primary) hypertension: I10
  • Hypertension and hypertensive center disease: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive heart disease, and chronic kidney disease: I13
  • Tobacco apply or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-ten
  • References

Different hypertension and heart disease, where the provider must determine whether a causal relationship exists, if the patient has hypertension and develops chronic kidney affliction, ICD-10 presumes a cause and effect human relationship and classifies the condition equally hypertensive chronic kidney disease. Notation, still, that if the chronic kidney disease came first, and then the combination falls into the secondary hypertension codes discussed afterward in this commodity.

Both ICD-9 and ICD-10 crave specifying the stage of the chronic kidney disease to properly code the condition. Very few patients accept a true glomerular filtration rate (GFR) measured and nearly staging relies on the estimated glomerular filtration charge per unit (eGFR). Most laboratory reports provide a race-based reference range. It is not uncommon for these estimates to have slight variability and for the patient'south staging to vary between stage 2 and 3. Annotation that ICD-ten differentiates stage 5 from end-stage renal disease by the need for chronic dialysis.

ICD-x requires first using an I12 code for the combined diagnosis of hypertension and chronic kidney disease:

  • I12.0, Hypertensive chronic kidney illness with stage five chronic kidney disease or end-stage renal illness,

  • I12.9, Hypertensive chronic kidney affliction with stage 1 through four chronic kidney affliction or unspecified chronic kidney illness.

These two codes require an additional N18 code to identify the stage of kidney affliction, with documentation typically referencing the most recent eGFR:

  • N18.1, Chronic kidney disease, stage 1,

  • N18.two, Chronic kidney illness, stage 2 (mild),

  • N18.3, Chronic kidney disease, stage three (moderate),

  • N18.4, Chronic kidney disease, stage 4 (severe),

  • N18.5, Chronic kidney disease, phase v,

  • N18.half-dozen, End-stage renal illness,

  • N18.9, Chronic kidney disease, unspecified.

Instance: You have been treating a 55-yearold black female for hypertension (I10) for the past five years. On her well-nigh recent role visit, you performed a comprehensive metabolic profile. All values were inside the laboratory reference range except her BUN and creatinine. The laboratory calculated her eGFR at 40 (mL/min/1.73mtwo). Repeat testing produces a like result. You update her diagnosis codes to I12.9 and N18.three.

Hypertension, hypertensive heart disease, and chronic kidney disease: I13

  • Abstract
  • Essential (primary) hypertension: I10
  • Hypertension and hypertensive heart illness: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive middle affliction, and chronic kidney affliction: I13
  • Tobacco utilise or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-10
  • References

To confuse matters further, if the patient has all three conditions (hypertension, heart disease, and chronic kidney disease), and then you need to document the relationship betwixt the hypertension and heart disease but assume the causal relationship between hypertension and chronic kidney disease. The documentation requirements are the same as what was outlined in a higher place.

The codes for the three-disease combination are numerically arranged past the caste of chronic kidney disease rather than the presence or absenteeism of center failure:

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

  • I13.10, Hypertensive heart and chronic kidney disease without eye failure with stage one through stage 4 chronic kidney illness, or unspecified chronic kidney disease,

  • I13.xi, Hypertensive heart and chronic kidney illness without heart failure with stage 5 chronic kidney disease, or cease-phase renal disease,

  • I13.2, Hypertensive eye and chronic kidney disease with heart failure and with phase 5 chronic kidney disease, or terminate-phase renal illness.

Equally with the two-combination codes, all of the three-combination codes require additional coding from the N18 serial to identify the stage of kidney disease. The three-combination codes that include heart failure also require additional coding from the I50 serial to specify the type and vigil of the failure.

Instance: The 55-twelvemonth-erstwhile female person in the above case presents to your office with some pedal edema, and on test you also discover some mild crackles in the base of her lungs. You order an echocardiogram that documents mild systolic heart failure. Her eGFR has remained stable. You update her diagnostic codes to I13.0 (Hypertensive center and chronic kidney disease with heart failure and with phase ane through 4 chronic kidney disease, or unspecified chronic kidney disease), I50.21 (Systolic, congestive, center failure, astute), and N18.iii (Chronic kidney disease, stage 3, moderate).

Tobacco use or exposure in individuals with hypertensive diseases

  • Abstruse
  • Essential (master) hypertension: I10
  • Hypertension and hypertensive heart disease: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive center illness, and chronic kidney disease: I13
  • Tobacco apply or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-x
  • References

All of the hypertension codes require an additional ICD-10 code if the patient is a electric current or former tobacco user. In most cases, y'all would utilize one of the following codes establish in chapter 5, "Mental, Behavioral, and Neurodevelopmental Disorders":

  • F17, Nicotine dependence,

  • F17.xx, Unspecified,

  • F17.21, Cigarettes,

  • F17.22, Chewing tobacco,

  • F17.29, Other tobacco product.

Each of these four categories has a required sixth grapheme:

  • 0, simple,

  • 1, in remission,

  • 3, with withdrawal,

  • 8, with other specified nicotine-induced disorder,

  • 9, with unspecified nicotine-induced disorder.

If you have non documented that a patient who uses tobacco is "dependent," then you would instead use the code for tobacco apply (Z72.0). The departure is non well-divers, but the Centers for Disease Control and Prevention's website states, "Tobacco utilise can lead to tobacco/nicotine dependence and serious wellness bug … Tobacco/nicotine dependence is a chronic condition that often requires repeated interventions."

Occupational and ecology exposure to tobacco should also be coded if the provider believes these are influencing the patient'due south wellness status. The codes are as follows:

  • Z57.31, Occupational exposure to ecology tobacco smoke,

  • Z72.0, Bug related to lifestyle, tobacco use,

  • Z77.22, Exposure to environmental tobacco smoke (includes 2nd-mitt smoke exposure and passive smoking),

  • Z87.891, Personal history of nicotine dependence.

The ICD-x manual partially explains the difference between Z87.891, "Personal history of nicotine dependence," and F17.211, "Nicotine dependence, cigarettes, in remission." Information technology states that a personal history code should exist used if a patient'due south condition no longer exists and is not being treated simply has the potential to recur and, therefore, may require continuous monitoring. The remission code would be appropriate if a patient is actively using a production to end smoking. Once the patient has stopped using such products, information technology is upward to the provider to decide when the patient's status would move from "in remission" to "personal history of."

Coding for secondary hypertension: I15

  • Abstruse
  • Essential (principal) hypertension: I10
  • Hypertension and hypertensive heart disease: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive heart disease, and chronic kidney disease: I13
  • Tobacco use or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-10
  • References

Although the master focus of this article has been essential hypertension, including comorbidities of heart failure and chronic kidney disease, there may be some patients in the primary intendance setting who accept hypertension secondary to other disease states. In these cases, providers cannot utilise the hypertension ICD-x codes discussed above. Instead, use the following codes:

  • I15.0, Renovascular hypertension,

  • I15.1, Hypertension secondary to other renal disorders,

  • I15.two, Hypertension secondary to endocrine disorders,

  • I15.eight, Other secondary hypertension,

  • I15.9, Secondary hypertension, unspecified.

The five secondary hypertension codes require that you also code the underlying condition. ICD-ten typically permits either the underlying condition or the secondary hypertension code to exist listed first depending on the reason for the patient encounter. The exception to this is I15.8, Other secondary hypertension. Because this is an "other" code, the "other" condition must be coded offset.

Adapting to ICD-10

  • Abstruse
  • Essential (primary) hypertension: I10
  • Hypertension and hypertensive eye affliction: I11
  • Hypertension and chronic kidney disease: I12
  • Hypertension, hypertensive middle illness, and chronic kidney illness: I13
  • Tobacco use or exposure in individuals with hypertensive diseases
  • Coding for secondary hypertension: I15
  • Adapting to ICD-10
  • References

If this introduction to the new hypertension codes has elevated your blood force per unit area, stop and take a deep breath. ICD-x coding is a big adjustment, but it will get easier with fourth dimension and practice. For more help, see the series overview and look for future articles in FPM.

ARTICLES IN FPM'S ICD-10 Serial

You tin can access the following articles in FPM's ICD-10 topic drove:

"ICD-x: Major Differences for Five Common Diagnoses," FPM, September/Oct 2015.

"ICD-x Sprains, Strains, and Automobile Accidents," FPM, May/June 2015.

"Digesting the ICD-x GI Codes," FPM, January/February 2015.

"Coding Common Respiratory Problems in ICD-x," FPM, November/December 2014.

"ICD-10 Simplifies Preventive Care Coding, Sort Of," FPM, July/August 2014.

"ICD-10 Coding for the Undiagnosed Problem," FPM, May/June 2014.

"How to Document and Code for Hypertensive Diseases in ICD-10," FPM, March/April 2014.

"10 Steps to Preparing Your Office for ICD-10 – Now," FPM, January/February 2014.

"Getting Set up for ICD-10: How It Will Affect Your Documentation," FPM, November/Dec 2013.

"The Beefcake of an ICD-10 Code," FPM, July/August 2012.

"ICD-ten: What You lot Need to Know Now," FPM, March/April 2012.

To see the full commodity, log in or purchase admission.

About the Author

Dr. Beckman, a family doctor, is vice president/chief medical officer for a health insurance company in Milwaukee, Wis.

Writer disclosure: no relevant financial affiliations disclosed.

Copyright © 2014 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make i printout of the material and may use that printout simply for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or afterwards invented, except as authorized in writing by the AAFP. Contact fpmserv@aafp.org for copyright questions and/or permission requests.

Near Contempo ISSUE

FPM E-Newsletter

Sign up to receive FPM's gratis, weekly e-newsletter, "Quick Tips & Insights."

Sign Up At present