Documenting and Coding Hypertension – Major Guidelines

Hypertension is a major health condition that must be properly managed. It has to be appropriately documented on medical claims.

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Recorded as a major health problem (particularly among the elderly) in the United States, hypertension occurs when your blood pressure increases to unhealthy levels. An individual’s blood pressure measurement takes into account how quickly blood is passing through your veins and the amount of resistance the blood meets while it’s pumping. An article published in the American Journal of Hypertension (April 2017) reports a rising trend in hospitalization for hypertensive emergency with reduction in hospital mortality during the last decade. Patients with acute cardio respiratory failure, chest pain, stroke, acute chest pain, or aortic dissection were at the most risk of higher hospital mortality among other complications.

Hypertension is a major contributor for heart disease and other medical problems. Furthermore, hypertension is often accompanied by co-morbid conditions such as diabetes mellitus, kidney damage, arteriosclerosis, obesity, CKD-3, and systolic dysfunction which complicate the treatment for blood pressure. The problem with this epidemic is very clear, untreated blood pressure often leads to multiple target organ complications. According to the research findings from the University of Miami Miller School Of Medicine, approximately 80 percent of first strokes are a consequence of preventable risk factors such as hypertension. Since the management of hypertension is challenging, it is vital to identify and treat blood pressure appropriately. It is very important for physicians to report this condition correctly with the right diagnosis codes. Medical coding companies should ensure correct coding of hypertension to track patients that require immediate treatment for this chronic medical condition.

Financial Payment System - Transition MACRA (Medicare Access and CHIP Reauthorization Act) — a Merit-based Incentive Payment System (MIPS) - primarily links physician reimbursement to quality of care rather than the volume of services. It is expected that this

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focus on quality will considerably improve efficiency and patient outcomes while reducing total costs. There are many potential factors that determine payment under MACRA, but the main theme is how effective and accurate the provider can be in the diagnosis, management and reporting of patient care. Whether it is hypertension or any other medical condition, there will be more potential for that provider to receive higher revenue. This represents a unique transition from the “fee-for-service reimbursement model” to a more “quality based Merit-Based" formula. In other words, quality replaces quantity.

The participating providers will need to report six quality measures contributing to their overall “Quality score”. Controlling the incidence of hypertension in patient population is one of the prominent ways to demonstrate quality. Hypertension is reported as a “high priority measure” that offers healthcare providers the opportunity to accumulate additional bonus points (that adds up to their overall score). Since quality is the most significant contributor to the MIPS Composite Performance Score, the impact of these bonus points can be financially significant.

Hierarchical Condition Category (HCC) Rating In simple terms, Hierarchical Condition Category (HCC) value rating is a year to year estimation of how much the care of an individual should cost, which in turn may affect reimbursement for that particular service. The more accurate the HCC value, the better a healthcare practice can ensure appropriate and fair reimbursement for the care that the patient requires over time.

There

are

other

benefits

of

promoting

accurate

documentation

of

hypertension when elevated blood pressure is present with other comorbidities. These may mainly include – hypersensitive chronic kidney disease

(stages

1-4)

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and

ESRD

and

hypersensitive

heart

disease

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with/without heart failure. Such co-morbidities affect how hypertension as a diagnosis needs to be accurately coded and also play a role in a provider's HCC rating. Accurate calculation of HCC rating by the correct coding of hypertensive disease also ensures a positive payment adjustment from payers participating in this diagnosis-based risk adjustment model.

Coding for Hypertension In ICD-10, there is only a single code for primary hypertension without comorbid heart or kidney disease

I10: Essential (primary) hypertension

However, when hypertension condition is diagnosed in combination with other conditions such as heart failure, chronic kidney disease (CKD) or heart disease – the codes essentially change. The accurate coding of hypertensive diseases may significantly affect HCC values – as this will determine proper and fair reimbursement from participating payers. The more accurate diagnosis code selection will lead to more accurate reimbursement rates.

Hypertension and Associated Conditions If a patient suffering from hypertension is confirmed to have co-morbid heart and/or kidney disease, it should be reported using ICD-10 codes in the following manner – Hypertension and Heart Disease This category is divided into malignant, benign, and unspecified essential hypertension with or without heart failure. There are only two codes for the same condition in ICD-10 such as 

I11.0 - Hypertensive heart disease with heart failure



I11.9 - Hypertensive heart disease without heart failure

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Hypertension and Chronic Kidney Disease If a person suffering from hypertension further develops chronic kidney disease, ICD-10 will regard that condition as hypertensive chronic kidney disease. However, if the chronic kidney disease comes first and then the combination, their codes fall under the secondary hypertension codes. In the case of hypertensive kidney disease, ICD-10 requires specifying the stage of the kidney disease and thereby distinguishes stage 5 from end-stage renal disease by the need of chronic dialysis. 

I12.0 - Hypertensive chronic kidney disease with stage 5 chronic kidney disease (CKD) or end-stage renal disease (ESRD)



I12.9 - Hypertensive chronic kidney disease with stage 1 through 4 chronic kidney disease (CKD) or unspecified chronic kidney disease (CKD)

Both these codes require an additional N18 code to specify the stage of kidney disease – 

N18.1 - Chronic kidney disease, stage 1



N18.2 - Chronic kidney disease, stage 2 (mild)



N18.3 - Chronic kidney disease, stage 3 (moderate)



N18.4 - Chronic kidney disease, stage 4 (severe)



N18.5 - Chronic kidney disease, stage 5



N18.6 - End-stage renal disease



N18.9 - Chronic kidney disease, unspecified

Hypertension, Heart Disease and Chronic Kidney Disease The ICD-10 codes for the three-disease combination ((if the patient has all the 3 conditions - hypertension, heart disease and chronic kidney disease) are primarily classified according to the degree of chronic kidney disease rather than the presence or absence of heart failure – www.outsourcestrategies.com

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

I13.0 -

Hypertensive heart and chronic kidney disease with heart

failure and with stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease 

I13.2 - Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end-stage renal disease



I13.10 - Hypertensive heart and chronic kidney disease without heart failure with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease



I13.11 - Hypertensive heart and chronic kidney disease without heart failure and with stage 5 chronic kidney disease, or end-stage renal disease

As mentioned above, the two-disease combination codes require additional codes from the N18 series to specify the different stages of kidney disease.

Tobacco Use or Exposure in Individuals with Hypertensive Diseases All of the hypertension codes require an additional ICD-10 code if the patient is a current or former tobacco user. The codes include 

F17 - Nicotine dependence



F17.20 - Unspecified



F17.21 - Cigarettes



F17.22 - Chewing tobacco



F17.29 - Other tobacco product

Each of these four categories requires a sixth character – 

0 – uncomplicated



1 – in remission

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

3 – with withdrawal



8 – with other specified nicotine-induced disorder



9 – with unspecified nicotine-induced disorder

On the other hand, if occupational and environmental exposure to tobacco is influencing the health status of your patient, the following ICD-10 codes must be used 

Z57.31- Occupational exposure to environmental tobacco smoke



Z72.0 - Problems related to lifestyle, tobacco use



Z77.22 - Exposure to environmental tobacco smoke (includes secondhand smoke exposure and passive smoking)



Z87.891- Personal history of nicotine dependence

Secondary Hypertension In cases of patients having hypertension secondary to other diseases, the above mentioned ICD-10 codes are not used. The secondary hypertension codes used in such a situation include 

I15.0 - Renovascular hypertension



I15.1 - Hypertension secondary to other renal disorders



I15.2 - Hypertension secondary to endocrine disorders



I15.8 - Other secondary hypertension



I15.9 - Secondary hypertension, unspecified

Reports from the Centers for Disease Control and Prevention (CDC, 2016 statistics) suggest that about 75 million American adults (29%) have high blood pressure—that is 1 out of every 3 adults. Hypertension, being one of the chronic health conditions, is a major risk factor for heart disease and other medical problems. Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.

Regular blood pressure readings can help you to detect this condition early. www.outsourcestrategies.com

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Treatment for hypertension includes both prescription medication and healthy

lifestyle

changes.

Healthcare

providers

can

focus

on

the

management of hypertensive conditions, while their partnering medical coding service providers ensure accurate reporting of the condition to meet CMS guidelines.

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