ICD-10-CM Coding for Hypertension, Chronic Kidney Disease and Hypertensive Heart Disease
Hypertensive heart disease refers to a group of disorders that includes heart failure, ischemic heart disease, and left ventricular hypertrophy.
It is the number one cause of death associated with high blood pressure.
While documenting the documentation must state :
- Heart failure due to hypertension) or
- Imply a causal relationship (hypertensive heart failure) to assign a code from category I11, Hypertensive heart disease.
Guidelines state that there is a presumptive cause-and-effect relationship between hypertension and chronic kidney disease.
In case a patient has all three conditions present : Hypertension, heart disease and chronic kidney disease, the guidelines state that the connection must be made for the heart disease and hypertension, but not for the Chronic Kidney Disease and hypertension.
The guidelines can be explained with the help of these examples:
EXAMPLE 1:
Diagnosis: Hypertension 2 and Chronic diastolic congestive heart failure.
The ICD10 coding will be:
I10 for Essential (primary) hypertension and
I50.32 for Chronic diastolic (congestive) heart failure
In this example, there is no causal relationship indicated hence, the two conditions are coded separately.
EXAMPLE 2:
Diagnosis:
Hypertension with hypertensive chronic diastolic congestive heart failure
ICD10 Coding will be:
I11.0 for Hypertensive heart disease with heart failure.
I50.32 for Chronic diastolic (congestive) heart failure.
In the above example the causal relationship is indicated; therefore, the first-listed code is now different.
And the instructional note under code I11.0 states that the second code is still necessary to identify the type of heart failure.
EXAMPLE 3:
Diagnosis : Hypertension and stage 3 CKD.
ICD10 Coding will be:
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
N18.3 Chronic kidney disease, stage 3 (moderate)