doesnt always cut it and improved documentation
is the key to more specific codes
for hypertension should never feel like a coin toss.
Heres how to get it right every time.
need to know whether a patients hypertension is malignant
or benign in order to select the most definitive ICD-9 code.
Unfortunately, physicians often dont provide adequate
documentation on hypertension and that can make assigning
a specific code impossible.
agree that improving physician documentation is the only
way to improve your coding specificity. Follow these three
easy steps to ensure your hypertension coding makes the
The real key to correct coding for hypertension lies
with physician documentation, and we need to educate our
physicians to tell us explicitly what type of hypertension
theyre treating, says Charla Prillaman, CPC, CHCO,
director of physician compliance for Carolinas Healthcare
System in Charlotte, NC. Physicians need to state the details
of a patients hypertension in the medical record,
for hypertension really comes down to documentation,
agrees Jaime Darling, CPC, a coder with Graybill
Medical Group in Escondido, Calif. Often physicians will
simply write hypertension in the diagnosis portion
of their notes, which leads a coder to nothing but 401.9
(Essential hypertension; unspecified), she says. Explain
to your physicians that adequate information for medical
purposes isnt always adequate for coding purposes.
Ask your physicians to indicate whether a patients
hypertension is malignant or benign, and also to define
how any other manifestations are related to the hypertension,
Darling recommends. For example, the physician should not
just document hypertension and renal disease, but should
indicate if the patients hypertension is causing renal
disease or if the renal disease is causing hypertension.
Determine malignant or benign
hypertension table in the ICD-9-CM manuals Index lists
three possible categories into which hypertension may fall:
Malignant, benign and unspecified. The fourth digit of the
hypertension code you report will differ depending on which
category you choose. For instance, youll report 401.0
for malignant essential hypertension, 401.1 for benign essential
hypertension and 401.9 for unspecified.
hypertension is a form of hypertension that progresses
rapidly, accompanied by severe vascular damage, according
to Tabers Cyclopedic Medical Dictionary, 19th Edition.
Malignant hypertension can be life threatening and may cause
a stroke, but is much less common than benign hypertension.
Common assumption: Because benign hypertension is
more common than malignant, physicians often assume they
are indicating benign hypertension when they simply write
hypertension, Prillaman says. But if the documentation
doesnt specifically state benign or malignant,
the only accurate choice you have is to report an unspecified
code, she adds.
Bright idea: If your physicians arent keen
on always having to write benign or malignant,
you might try this: Institute a set policy within your practice
stating that, unless the physician specifies otherwise in
the chart, he is indicating benign hypertension whenever
he simply writes hypertension, Darling suggests.
Such a policy will allow you to rightfully move beyond unspecified
to report a more specific code.
Identify primary or secondary
When documenting, physicians have to learn to link the patients
hypertension to any other manifestations, Darling says.
And coders have to learn to discern the manifestations properly
to assign the correct code.
If the patients hypertension is primary, meaning that
another condition is not causing the hypertension, then
you need to list the hypertension code first. Then list
any manifestations as secondary diagnoses, Darling says.
However, patients sometimes have hypertension with another
condition, such as renal disease, and there is one code
that includes both conditions, she adds. For instance, the
403 code series indicates hypertensive renal disease, and
the 404 series indicates hypertensive heart and renal disease.
#1: If your physician documents a patient with benign
hypertensive renal disease with renal failure, you would
report 403.11. You need only this one code to describe the
patients entire condition.
#2: If your physician treats a patient with benign hypertensive
heart disease with heart failure, you would report 402.11.
This code indicates the patients entire hypertensive
status, but you would also need to report an additional
code to specify the type of heart failure, such as 428.0
(Congestive heart failure, unspecified).
Note: If the physician documents the patient has
heart disease due to hypertension, he should also indicate
whether the disease is with or without heart failure, Darling
says. This [distinction] will help the coder select
the best code in the 402 or 404 categories, she adds.
And if the patient does have heart failure, remember to
assign a separate code to indicate the type of heart failure.
A patient has secondary hypertension if the hypertension
is due to or caused by another condition. ICD-9-CM
defines secondary hypertension as high arterial blood
pressure due to or with a variety of primary diseases, such
as renal disorders, CNS disorders, endocrine and vascular
secondary hypertension, you should report the causal condition
as the primary diagnosis and the hypertension as secondary.
For example, if a patient has primary aldosteronism that
is causing benign hypertension, you might report 255.10
(Primary aldosteronism) as the primary diagnosis and 405.19
(Secondary hypertension; benign; other) as the secondary.