Alright, hypertension and chronic kidney disease. That’s Alicia’s. I guess I’ll bring that answer sheet up.
Alicia: Yeah. And you know what? You guys, I just took a class on this so it’s very exciting. I just feel like my little spongy brain has absorbed all kinds of information and it was a lot of fun. I’ve struggled with this too.
So hypertension icd 9 codes. This is abbreviated HTN if you guys didn’t know that you know, what is hypertensive disease? And it’s so broad that you know, you can’t really define it per se. But the main thing about hypertension is you want to know is it essential or primary hypertension? Okay… and it’s 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 that… 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.
Hypertension ICD 9 Codes Video
So probably the first code… I always laugh because the first code that most new coders learn is 401.9 because you see it a lot especially if you’re coding for Medicare patients. Everybody seems to have hypertension. So let’s see, the physician must document if the patient’s hypertension is benign or malignant in order to get your 4th digit. Okay so if it doesn’t say whether it’s 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? That’s something else. That’s 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 patient’s taking Benicar and they refill their Benicar for 3 months you know, what would you use? You’re actually going to use the 401.9 because Benicar is used to control hypertension. So that way, it says elevated blood pressure. You’re not going to use that 796.2. They’re 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 it’s benign hypertension. In order for it to be 401.0, it has to be malignant in the documentation. And if it doesn’t state whether it’s benign or malignant then you’re going to default to 401.9. And for you new coders out there, they’re just starting to go through the codes. If something ends in a 9 in ICD 9, it usually means it’s unspecified. Okay, that’s your… you’ll 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 like… you have hypertension and CAD then you know, they have to… the doctor has to specifically say that they’re linked for you to be able to code certain codes. But with hypertension and CKD, you don’t have to have support. So in other words, they’re saying if the patient has a chronic kidney disease and they have hypertension, you’re 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 for… is the main code for chronic kidney disease. Okay so that’s what they’re saying that if your patient has hypertension and chronic kidney disease, you’re not going to use a 401 code. You’re going to use a 403 code and then you’re 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 it’s hypertensive heart disease you know, it has to say due to or all that terminology to link it, you don’t have to do that with CKD. Okay, the appropriate code, 585 is for chronic kidney disease and it is a… it should be your secondary.
So when you get into the primary and the secondary… so let’s 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 don’t have to memorize it. So you’ll use the 403 to identify that it’s hypertensive. The CKD unspecified includes these things: chronic renal disease, chronic renal failure – not otherwise specified or chronic renal insufficiency. That all means CKD. Okay so as you’re going through terminology and your anatomy and physiology courses and stuff like that then you’ll start seeing these other terms and you’ll know that’s all chronic kidney disease. It’s 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. That’s… but your guidelines tell you that in the book so you don’t have to worry about memorizing that.
So here’s 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 it’s 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 there’s 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, that’s not all the question. But let’s 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. He’s got chronic kidney disease stage 3 which is 585.3. You don’t have to guess, I told you that’s the right answer. But what are we going to do with the hypertension? You’ve got 401.1 which is benign, 401.9 which is essential, 403.90 which is… I have to see the hypertensive table to see what it’s 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, we’ll show you that.
Laureen: Do you see it?
Alicia: The hypertension table? Do you have it?
Laureen: I did. Oh you don’t maybe because the poll’s going on. You can’t see it.
Alicia: Oh yeah. So if I give you that information, real quick, which one do you think that you’re 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 one’s taking a little time, huh?
Alicia: Yeah, just guess.
Boyd: 50% voted now.
Alicia: That’s probably good.
Boyd: 62, okay great. I’m going to go and close it in 3, 2, 1… 70% voted. Great, guys. Thank you. And closing the poll and showing the poll.
Alicia: You’re 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 you’re not going to use the 401.1 because that’s benign and 401.9 is unspecified. But when you use your hypertension table which is in the middle of the index under the H’s, it’s before your poison control table, it’s going to tell you that if your person has hypertension and then they… it says “with chronic kidney disease” you’re 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 you’re going to scroll down until you find… oh right there, with chronic kidney disease. You know your person has stage 3 so 1 through 4 or unspecified. So there’s your choices, 403.00, 403.10 and 403.90. Oh, doesn’t Laureen’s nails look nice. And since benign was not mentioned, you cannot use the 403.00 and the 403.10. It is unspecified, 403.90.