Chapter 9: Diseases of the Circulatory System (I00-I99): There is a significant change when coding for hypertension regarding “with” documentation, revised heart disease guideline, additional instruction to chronic kidney disease documentation and coding for *hypertensive crisis.
- The classification presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement, as the two conditions are linked by the term “with” in the Alphabetic Index. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated.
- Chronic Kidney Disease has always been assumed to be related to hypertension; heart failure was not and required the physician to specifically state that. “With” is much more liberal than “due to”.
- Hypertension ICD-10-CM Official Guidelines for Coding and Reporting FY 2017
| Diagnosis | Category Code Assignment | Code Instruction |
| Hypertension with Heart Disease | Hypertension with heart conditions classified to I50.- or I51.4-I51.9, are assigned to a code from category I11, Hypertensive heart disease. | Use an additional code from category I50, Heart failure, to identify the type of heart failure in those patients with heart failure.ICD-10-CM Official Guidelines for Coding and Reporting FY 2017 Page 43 of 114
The same heart conditions (I50.-, I51.4-I51.9) with hypertension are coded separately if the provider has specifically documented a different cause. Sequence according to the circumstances of the admission encounter. |
| Hypertensive Chronic Kidney Disease | Assign codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present.CKD should not be coded as hypertensive if the physician has specifically documented a different cause. | The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease.See Section I.C.14. Chronic kidney disease.
If a patient has hypertensive chronic kidney disease and acute renal failure, an additional code for the acute renal failure is required. |
| Hypertensive Cerebrovascular Disease | For hypertensive cerebrovascular disease, first assign the appropriate code from categories I60-I69. | Followed by the appropriate hypertension code. |
| Hypertensive Heart and Chronic Kidney Disease | Assign codes from combination category I13, Hypertensive heart and chronic kidney disease, when there is hypertension with both heart and kidney involvement. If heart failure is present, assign an additional code from category I50 to identify the type of heart failure. | The appropriate code from category N18, Chronic kidney disease, should be used as a secondary code with a code from category I13 to identify the stage of chronic kidney disease.See Section I.C.14. Chronic kidney disease. The codes in category I13, Hypertensive heart and chronic kidney disease, are combination codes that include hypertension, heart disease and chronic kidney disease. Includes note at I13 specifies that the conditions included at I11 and I12 are included together in I13. If a patient has hypertension, heart disease and chronic kidney disease, then a code from I13 should be used, not individual codes for hypertension, heart disease and chronic kidney disease, or codes from I11 or I12. For patients with both acute renal failure and chronic kidney disease, an additional code for acute renal failure is required |
| Hypertensive Retinopathy | Subcategory H35.0, Background retinopathy and retinal vascular changes, should be used with a code from category I10 – I15, Hypertensive disease to include the systemic hypertension. | The sequencing is based on the reason for the encounter. |
| Hypertension, Secondary | Secondary hypertension is due to an underlying condition. Two codes are required: one to identify the underlying etiology and one from category I15 to identify the hypertension. | Sequencing of codes is determined by the reason for admission / encounter. |
| Hypertension, Transient | Assign code R03.0, Elevated blood pressure reading without diagnosis of hypertension, unless patient has an established diagnosis of hypertension. | Assign code O13.-, Gestational [pregnancy-induced] hypertension without significant proteinuria, or O14.-, Pre-eclampsia, for transient hypertension of pregnancy. |
| Hypertension, Controlled | This diagnostic statement usually refers to an existing state of hypertension under control by therapy. | Assign the appropriate code from categories I10-I15, Hypertensive diseases. |
| Hypertension, Uncontrolled | Uncontrolled hypertension may refer to untreated hypertension or hypertension not responding to current therapeutic regimen. | In either case, assign the appropriate code from categories I10-I15, Hypertensive diseases. |
| Hypertensive Crisis * | Assign a code from category I16, Hypertensive crisis, for documented hypertensive urgency, hypertensive emergency or unspecified hypertensive crisis. Code also any identified hypertensive disease (I10-I15). | The sequencing is based on the reason for the encounter. |
* Hypertensive Crisis: Is it an urgency or emergency?
The index of the current version of ICD-10-CM for “urgency, hypertensive,” directs you to the general Hypertension entry at I10. However, there is a difference between hypertensive crisis and plain hypertension. According to the American Heart Association, hypertensive crises can present as hypertensive urgency or as hypertensive emergency.
- In hypertensive urgency: the BP is elevated to 180 or higher for the systolic or 110 or higher for the diastolic pressure, without associated organ damage.
- In hypertensive emergency: this is a more critical of the two conditions. The BP elevations occur (exceeding 180/110) but the hypertension is always accompanied by symptoms of organ damage.
ICD-10-CM added the following new codes to go along with this accepted hypertensive crisis terminology:
- I16.0, Hypertensive urgency
- I16.1, Hypertensive emergency
- I16.9, Hypertensive crisis, unspecified.
Note: If the documentation doesn’t specify urgency or emergency, one has to report the unspecified code.
Referenced Documents: