Ch 12 CM- Cardiovascular DX's

Hypertension

One of the few times you get to PRESUME something.
Heart and kidney involvement when hypertension is involved is always presumed to be related/due to.
Linked by the term "with" in the index
If the index doesnt link other terms with WITH or DUE TO then the doctor does have specify that they are related

The Guideline

Normal = 120/80 or less
Pre-Hypertension = 120-139/80 or less
Stage 1 HTN = 130-139/80-90
Stage 2 HTN= 140+/90+

Based on an average - not a one time reading : NOT OUR JOB TO DEFINE HTN

When coding HTHD, code also the type of heart failure (I50.--)

If the heart conditions are documented as unrelated to HTN, then code them separately and sequence based on admission

​The Guideline

Caused by prolonged HTN, heart wall thickens, heart has to work harder to pump the blood.
Does not happen to everyone especially if HTN is controlled

I11

When coding HTCKD use the appropriate I12 code to identify the stage (i.e. stage 5)
as well as the N18 code the the appropriate stage

​The Guideline

When both HTN and CKD are documented, presume they are related and code I12

Don't use this code if CKD is documented as NOT related to HTN

I12

HTHD with CKD

When a patient has both heart and kidney involvement with hypertension, use code I13 rather that coding each separately (I11, I12)
Then add a code for heart failure if present, and the stage of CKD (N18).
HTHD w/ CKD = I13.--, I50.--, N18.--


Acute renal failure should also be coded if present

Hypertensive Retinopathy gets a code from I35.0 background retinopathy along with the appropriate HTN code. Sequence based on admission

IC9a5

Code first I60-I69 followed by the appropriate HTN code when the patient has Hypertensive Cerebrovascular Disease

IC9a4

meaning its not going to stick around. Code as ELEVATED BP

Unless the patient is pregnant
then code Gestational HTN or PreEclampsia

Transient HTN

HTN due to something else, NOT something due to HTN.

2 codes required

Sequencing based on admission

Secondary HTN

may be called hypertensive urgency or hypertensive emergency, code I16 along with any other necessary code from I10-I15.
Sequence based on the encounter

Hypertensive Crisis

controlled usually means via therapy, uncontrolled could mean unresponsive to therapy or untreated. Either way code I10-I15

Controlled v. Uncontrolled HTN

IC9b

If a patient has angina and CAD, they are presumed to be related and should be coded with a combo code. Do not assign a separate code for the angina.

CAD of Native - the patients own coronary arteries
CAD of Bypass - the patients bypass vessel from prior CABG
CAD of Transplant- vessels of a transplanted heart - be careful

IC9c

No presuming here!
The documentation MUST indicate that the CVA was due to the procedure-
was it hemorrhage or infarction
was it intraoperative (during) or postoperative (after)

Cerebral hemorrhage further classifies the type of procedure performed

It is possible to have a new CVA (stroke) while still suffering from sequelae of an old stroke, so both codes can be used together.

New and old

I69 includes conditions that frequently occur due to CVA (hemiplegia, hemiparesis, etc.)

Dont use if the patient has an old CVA but no deficits (use hx of)

Sequela

Cerebrovascular
Accidents (Strokes)

NSTEM and STEMI

If a type 1 NSTEMI evolves into a STEMI, then code the STEMI code instead

If a STEMI converts back to STEMI due to thrombolytics, still code the STEMI