- 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.