March 25, 2010 | | Comments 2
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A coder dissects hypertension code I10 and asks why type no longer matters?

Hypertension has always been a pet peeve of mine as a coder in ICD-9. We have three different fourth digits to identify the following “types” of hypertension:

  • Malignant (0 )
  • Benign (1)
  • Unspecified (9)

As most coders would agree, physicians never document “benign” hypertension. When discussing the issue with fellow coders around the country, I’ve heard that some see “malignant” documented on occasion whereas others say they never see “benign” or “malignant” documented. Therefore, we all agree that coders generally use good ol’ code 401.9 for hypertension.

Because we know the difference between “malignant” and “benign,” I always wondered why we couldn’t assume that if it isn’t “malignant” then it must be “benign.” Instead, we have to use a code that says “unspecified.” I myself hate having to code anything as unspecified.

The other issue is that physicians like to use the term “essential” to identify the typical type of hypertension, so I always wondered why “essential” was never linked to a specific type of hypertension. Or why “hypertensive crisis” doesn’t link to a specific type of hypertension.

I’ve been hoping that I can rely on ICD-10 to fix this issue for me. Well, I guess you can say they did. When you look up Hypertension in the ICD-10 Alphabetic Index, it reads:

Hypertension, hypertensive (accelerated) (benign) (essential) (idiopathic) (malignant) (systemic) I10

So, when you go to ICD-10-CM code I10 in the Tabular List, it states:

I10 Essential (primary) hypertension

Includes: high blood pressure

hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic)

Excludes1: hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16)

Excludes2: essential (primary) hypertension involving vessels of brain (I60-I69)

essential (primary) hypertension involving vessels of eye (H35)

So it appears that it will no longer matter whether hypertension is malignant or benign when we start coding with ICD-10-CM. This still makes me question then why is it important in ICD-9 to make the distinction? As we all know, “malignant” hypertension is one of the co-morbid conditions that can make a difference when coding in the inpatient setting. Does that mean that it will no longer make a difference when we get to ICD-10? Then why does it make a difference now?

I have looked to the current ICD-10 guidelines to see if it would enlighten me as to why the change and found no clues. Therefore, it’s my opinion that this change has happened because of our lack of documentation over the years of the type of hypertension, and therefore it will no longer make a difference when we reach ICD-10.

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Jennifer Avery About the Author: Jennifer Avery, CCS, CPC, CPC-H, CPC-I, has extensive experience with coding for both physician and hospital services. Prior to joining HCPro, Inc., she worked for Health Partners Investments, LLC. a medical practice management company, as a Lead Coder where her duties included coder training, auditing and coding for all new specialty physicians and served as back-up coder for all other coders during vacations and back-log. Avery was also a Coding Consultant for Coding by the Numbers where her duties included coding for in-patient services on an as needed basis. Avery holds both Associates in Health Claims Management and Medical Assisting from Davenport University, Granger, Indiana. Avery currently serves as President of her local chapter of the American Academy of Professional Coders in Oklahoma City.

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  1. Jennifer,
    As a clinical documentation specialist, it has been difficult to have a physician document accelerated/malignant hypertension.I enjoyed your article and glad to hear that ICD-10 will take care of this problem. It will be intersting to see how that transition plays out.Are there any courses/certifications relating to ICD-10?
    I would like to ask your opinion though on something unrelated to your article.
    I am an RN wit 20+ yrs critical care experience and i have been a CDS for 2 yrs. I would like to persue a career in some form of consulting/auditing for physician practice groups or possibly hospital settings.I plan on obtaining my CCS certification this summer. In your experience, which avenue should I take in order to prepare myself for a career in Coding/ compliance consulting? Which other certifications should I look into?

    Thank you and I look forward to hearing back from you.

    Sincerely,
    Gisele

  2. Hi Jennifer,

    I have been trying to catch up on my reading, and came across a posting on the blog.
    I am an RN with 30 years experience.
    Years ago I worked as a “Medical Reviewer” in which we audited the financial bill in the hospital in patient bill for accuracy; lost or unbilled revenue along with overcharges.
    The last 2-3 I have worked reviewing Medical records for Utilization Review Projects, HEDIS reviews, MCR risk adjustments.
    There appears to be a large selection for certification;
    CDS, Nurse Auditor, Medical Doc. Specialist just to name a few.
    I do alot of self studying on the internet.
    What would you suggest to persue?

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