ICD 9 Coding â€" Coding Hypertension and Chronic Kidney Disease
Alright, hypertension and chronic kidney disease.
ThatÃs AliciaÃs. I guess IÃll bring that
answer sheet up.
Alicia: Yeah. And you know what? You guys,
I just took a class on this so itÃs very
exciting. I just feel like my little spongy
brain has absorbed all kinds of information
and it was a lot of fun. IÃve struggled with
this too.
So hypertension, abbreviated HTN if you guys
didnÃt know that you know, what is hypertensive
disease? And itÃs so broad that you know,
you canÃt really define it per se. But the
main thing about hypertension is you want
to know is it essential or primary hypertension?
OkayÖ and itÃs going to mean, is there no
underlying condition that is causing the blood
pressure to increase? Okay so what percentage
do you think is essential or primary hypertension?
In fact, 95% is essential and unless blood
pressure readings are very high, efforts to
control blood pressure are usually based on
things thatÖ you can just change in your
lifestyle. You know, you can lose weight.
You can exercise. You can you know, reduce
your salt. You know, reduce your stress. Only
10% have a secondary hypertension which would
be under category 405.
So probably the first codeÖ I always laugh
because the first code that most new coders
learn is 401.9 because you see it a lot especially
if youÃre coding for Medicare patients. Everybody
seems to have hypertension. So letÃs see,
the physician must document if the patientÃs
hypertension is benign or malignant in order
to get your 4th digit. Okay so if it doesnÃt
say whether itÃs benign or malignant then
you have to use 401.9 which, by the way, translates
in ICD 10 as I10 which I think is kind of
fun. So now you already know an ICD 10 code.
Okay so what would you code if you have a
diagnosis of elevated blood pressure without
a diagnosis of hypertension? ThatÃs something
else. ThatÃs actually 796.2 which reads elevated
blood pressure, reading without diagnosis
of hypertension. Okay, what if you have an
encounter of elevated blood pressure and then
the patientÃs taking Benicar and they refill
their Benicar for 3 months you know, what
would you use? YouÃre actually going to use
the 401.9 because Benicar is used to control
hypertension. So that way, it says elevated
blood pressure. YouÃre not going to use that
796.2. TheyÃre actually treating them for
hypertension so you would use the 401.9.
Okay, we need to make sure that the patient
has hypertension from the documentation in
order to code the hypertension though. So
as we scroll down, these are the key ones
that you need to know in order to code 401.1.
It has to say itÃs benign hypertension. In
order for it to be 401.0, it has to be malignant
in the documentation. And if it doesnÃt state
whether itÃs benign or malignant then youÃre
going to default to 401.9. And for you new
coders out there, theyÃre just starting to
go through the codes. If something ends in
a 9 in ICD 9, it usually means itÃs unspecified.
Okay, thatÃs yourÖ youÃll notice that as
you go along.
Now for your chronic kidney disease, the CKD.
So some diagnoses have to be supported with
link you know, they have to link in likeÖ
you have hypertension and CAD then you know,
they have toÖ the doctor has to specifically
say that theyÃre linked for you to be able
to code certain codes. But with hypertension
and CKD, you donÃt have to have support.
So in other words, theyÃre saying if the
patient has a chronic kidney disease and they
have hypertension, youÃre going to go to
your hypertensive table and use those codes.
So as we scroll down to CKD for our next page,
assign codes from category 4 or 3, hypertensive
chronic kidney disease when conditions classified
to category 585 or 587 or present with hypertension.
Now, that may sound kind of scary to new coders
but 585 is the code forÖ is the main code
for chronic kidney disease. Okay so thatÃs
what theyÃre saying that if your patient
has hypertension and chronic kidney disease,
youÃre not going to use a 401 code. YouÃre
going to use a 403 code and then youÃre going
to get the proper kidney disease code.
Okay, unlike hypertension, like I said before
with heart disease where it has to say the
patient has heart disease and itÃs hypertensive
heart disease you know, it has to say due
to or all that terminology to link it, you
donÃt have to do that with CKD. Okay, the
appropriate code, 585 is for chronic kidney
disease and it is aÖ it should be your secondary.
So when you get into the primary and the secondaryÖ
so letÃs say you know, it states person has
hypertensive chronic kidney disease. The 585
is going to go second and the 403 will go
first and your guidelines in your manual tell
you this. You donÃt have to memorize it.
So youÃll use the 403 to identify that itÃs
hypertensive. The CKD unspecified includes
these things: chronic renal disease, chronic
renal failure ñ not otherwise specified or
chronic renal insufficiency. That all means
CKD. Okay so as youÃre going through terminology
and your anatomy and physiology courses and
stuff like that then youÃll start seeing
these other terms and youÃll know thatÃs
all chronic kidney disease. ItÃs all lumped
under that umbrella. Okay so acute and not
otherwise specified renal insufficiency remains
classified as 593.9, just throwing that in
there.
Okay so if a specific CKD or end stage renal
disease are both documented, you code only
the end stage renal disease. ThatÃsÖ but
your guidelines tell you that in the book
so you donÃt have to worry about memorizing
that.
So hereÃs your little reminder: hypertension
in CKD presumes that the cause and effect
relationship, the HTN and the CKD are going
to be 403.90 and 585.9. The 585 is kind of
nice because itÃs kidney disease and there
are stages for it. And stage 1 is like 1 or
stage 3 is .3, .9 is unspecified.
So I think is that the last of the page? I
think thereÃs a poll for that where I gave
an example of a question. There you go.
So patient seen today for review of his hypertension.
Oh, thatÃs not all the question. But letÃs
say its date. Patient was seen today for review
of his hypertension and is to continue his
medication for chronic kidney disease stage
3. Okay so it said that so now you know. HeÃs
got chronic kidney disease stage 3 which is
585.3. You donÃt have to guess, I told you
thatÃs the right answer. But what are we
going to do with the hypertension? YouÃve
got 401.1 which is benign, 401.9 which is
essential, 403.90 which isÖ I have to see
the hypertensive table to see what itÃs actually
called. But 403.10 is benign hypertension
associated with CKD. So 403.90 off the top
of my head is hypertension with chronic kidney
disease. If we had the hypertension table,
weÃll show you that.
Laureen: Do you see it?
Alicia: The hypertension table? Do you have
it?
Laureen: I did. Oh you donÃt maybe because
the pollÃs going on. You canÃt see it.
Alicia: Oh yeah. So if I give you that information,
real quick, which one do you think that youÃre
going to pick? You have to have your terminology.
So patient was seen today for review of his
hypertension. He is to continue his meds for
his stage 3 chronic kidney disease.
Boyd: This oneÃs taking a little time, huh?
Alicia: Yeah, just guess.
Boyd: 50% voted now.
Alicia: ThatÃs probably good.
Boyd: 62, okay great. IÃm going to go and
close it in 3, 2, 1Ö 70% voted. Great, guys.
Thank you. And closing the poll and showing
the poll.
Alicia: YouÃre right. 403.90 because in the
hypertension table, that is the unspecified,
whether benign or malignant hypertension when
a person has chronic kidney disease. Whereas
the 403.10 was benign, I believe, hypertension
when the person has chronic kidney disease.
And youÃre not going to use the 401.1 because
thatÃs benign and 401.9 is unspecified. But
when you use your hypertension table which
is in the middle of the index under the HÃs,
itÃs before your poison control table, itÃs
going to tell you that if your person has
hypertension and then theyÖ it says ìwith
chronic kidney diseaseî youÃre going to
use these codes. It works just like that poison
control table that we used in previous webinars.
Laureen: Alright, great. But did you need
to show anything in the hypertension table?
Alicia: There you go, guys. See real quick
there? Now if you look down, this is all the
different hypertension codes. Look up at the
top. You got malignant, 401.0. 401.1 is benign.
401.9 is unspecified. Then you go down and
you find your person has chronic kidney disease.
So youÃre going to scroll down until you
findÖ oh right there, with chronic kidney
disease. You know your person has stage 3
so 1 through 4 or unspecified. So thereÃs
your choices, 403.00, 403.10 and 403.90. Oh,
doesnÃt LaureenÃs nails look nice. And since
benign was not mentioned, you cannot use the
403.00 and the 403.10. It is unspecified,
403.90.
https://www.youtube.com/watch?v=1pqaapHRqBM
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https://www.youtube.com/watch?v=bVOceu5EbmA
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