Understanding ICD-10 Codes for Hypertension: A Comprehensive Guide
Table of Contents
ICD-10 codes for hypertension
|I10||Essential (primary) hypertension, benign|
|I11||Hypertensive heart disease|
|I12||Hypertensive chronic kidney disease|
|I13||Hypertensive heart disease and chronic kidney disease|
|I15.1||Hypertension secondary to other renal diseases|
|I15.2||Hypertension secondary to endocrine disorders|
|I15.3||Hypertension secondary to drugs|
|I15.4||Hypertension secondary to other diseases|
|I15.8||Other secondary hypertension|
|I15.9||Secondary hypertension, unspecified|
|I16.9||Hypertensive crisis, unspecified|
When coding for hypertension, it is important to note the following:
High blood pressure, or hypertension, occurs when the force of blood against the artery walls is consistently higher than normal. This can induce blood vessel and organ injury over time. When hypertension affects the brain’s blood vessels, migraines may result. The migraines could be caused by an increase in blood vessel pressure or by a constriction of the blood vessels, which reduces blood supply to the brain. Headaches caused by hypertension are typically described as pulsating pain on both sides of the head, which may be accompanied by vertigo or nausea.
Hypertensive heart disease
ICD-10-CM presumes a causal relationship between hypertension and heart involvement and classifies hypertension and heart conditions to category I11 (hypertensive heart disease) because the two conditions are linked by the term “with” in the Alphabetic Index of ICD-10-CM. These conditions should be coded as related even in the absence of provider documentation linking them. Code first I11.0 (hypertensive heart disease with heart failure) as instructed by the note at category I50 (heart failure). If the provider specifically documents different causes for the hypertension and the heart condition, the heart condition (I50.-, I51.4 to I51.9) and hypertension are coded separately.
Hypertension and Heart Failure
Hypertension and CKD
When the diagnostic statement includes both hypertension and CKD, ICD-10-CM assumes there is a cause-and-effect relationship. A code from category I12 (hypertensive CKD) is assigned because the two conditions are linked by the term “with” in the Alphabetic Index of ICD-10-CM. These conditions should be coded as related even in the absence of provider documentation linking them, unless the documentation clearly states the conditions are unrelated.1
A fourth character is used with category I12 to indicate the stage of the CKD. The appropriate code from category N18 should be used as a secondary code to identify the stage of CKD.
Hypertensive cerebrovascular disease
|Hypertensive retinopathy||Subcategory H35.0 (background retinopathy and retinal vascular changes) should be used with a code from category I10 to I15 (hypertensive disease to include the systemic hypertension).|
Two codes are required — one to identify the underlying etiology and one from category I15 to identify the hypertension. For example:
A code from category I16 (hypertensive crisis) is assigned for any documented hypertensive urgency, hypertensive emergency or unspecified hypertensive crisis. Report two codes, at a minimum, for hypertensive crisis. The crisis code is reported in addition to the underlying hypertension code (I10 to I15).
- Hypertensive urgency: I16.0
- Hypertensive emergency: I16.1
- Hypertensive crisis, unspecified: I16.9
More coding tips
Blood pressure and medication management should be assessed at every encounter involving a hypertensive patient. Clarity is important in documenting hypertension. Ensure that the diagnosis is captured by noting it in the medical record documentation:
- Specify a pregnant patient with hypertension as having a pre-existing, gestational, pre-eclampsic or eclampsic hypertension.
- Document and code the smoking status of a patient with hypertension:
- For current smokers: use category 17 codes
- Personal history of tobacco dependence: Z87.891
- Tobacco use: Z72.0
- Exposure to environmental tobacco smoke: Z57.31
- Document any causal relationship between hypertension and background retinopathy or other conditions in which the hypertension caused vascular changes and organ damage.
Strategies for success
- Improve the accuracy of BP measurements performed by your clinical staff by:
- Providing training materials from the American Heart Association.
- Conducting BP competency tests to validate the education of each clinical staff member.
- Making a variety of cuff sizes available.
- Instruct your office staff to recheck BPs for all patients with initial recorded readings greater than systolic 140 mm Hg and diastolic of 90 mm Hg during outpatient office visits; have your staff record the recheck in the patient’s medical records.
- Educate your patients (and their spouses, caregivers or guardians) about the elements of a healthy lifestyle, such as:
- Heart-healthy eating and low-salt diet.
- Smoking cessation and avoiding secondhand smoke.
- Adding regular exercise to daily activities.
- Home BP monitoring.
- Ideal body mass index.
- The importance of taking all prescribed medications as directed.
- Remember to include the applicable Category II reporting codes on the claim form to help reduce the burden of HEDIS medical record review.
Imtiaz Ahmad, MD, MPH, FCCP
Dr. Imtiaz Ahmad is a highly qualified physician, Board Certified in Pulmonary and Sleep Medicine. He has been actively serving the community of Lee County, Florida since 2004, with a strong focus on a proactive healthcare approach. Dr. Ahmad has received advanced training from some of the most prestigious institutions, including Harvard University, Cornell University, State University of New York at Brooklyn, and the University of Mississippi. SOMNAS is a medical facility that is committed to improving and maintaining the health of patients with sleep disorders. The expert team at SOMNAS is known for their compassionate and high-quality care. They offer unparalleled treatment and care to patients on the Gulf Coast of Florida, ensuring a better and healthier life for them.
DocCharge: Be productive again! Practice analytics, mobile charge capture, HIPAA compliant messaging, and tools for billers.
DocCharge is a mobile physician productivity platform enabling physicians and clinicians to save time by efficiently capture patient billings, communicate with back office and maximize revenue by avoiding lost charges using real-time analytics on a mobile device. Designed by a physician for fellow physicians, residents/fellows, and mid-level providers, DocCharge maximizes one’s productivity. Practice Administrators and outsourced billing companies find the application very intuitive, thus improving practice efficiency and revenue.
DocCharge is transforming healthcare data into useful and actionable insights, thereby allowing partner subscribers to focus their resources on the core business of providing high quality patient care. For more information, visit www.DocCharge.com, email: contact@DocCharge.com.