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ICD 9 Coding — Coding Hypertension and Chronic Kidney Disease

September 13, 2019


Alright, hypertension and chronic kidney disease. Thatís Aliciaís. I guess Iíll bring that answer sheet up. Alicia: Yeah. And you know what? You guys, I just took a class on this so itís
very exciting. I just feel like my little spongy brain has
absorbed all kinds of information and it was a lot of fun. Iíve struggled with this too. So hypertension, abbreviated HTN if you guys
didnít know that you know, what is hypertensive disease? And itís so broad that you know, you canít
really define it per se. But the main thing about hypertension is you
want to know is it essential or primary hypertension? OkayÖ and itís 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 thatÖ 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. So probably the first codeÖ I always laugh
because the first code that most new coders learn is 401.9 because you see it a lot especially
if youíre coding for Medicare patients. Everybody seems to have hypertension. So letís see, the physician must document
if the patientís hypertension is benign or malignant in order to get your 4th digit. Okay so if it doesnít say whether itís 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? Thatís something else. Thatís 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 patientís taking Benicar and they refill their Benicar for
3 months you know, what would you use? Youíre actually going to use the 401.9 because
Benicar is used to control hypertension. So that way, it says elevated blood pressure. Youíre not going to use that 796.2. Theyíre 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 itís benign hypertension. In order for it to be 401.0, it has to be
malignant in the documentation. And if it doesnít state whether itís benign
or malignant then youíre going to default to 401.9. And for you new coders out there, theyíre
just starting to go through the codes. If something ends in a 9 in ICD 9, it usually
means itís unspecified. Okay, thatís yourÖ youíll 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 likeÖ you have hypertension and CAD then you know,
they have toÖ the doctor has to specifically say that theyíre linked for you to be able
to code certain codes. But with hypertension and CKD, you donít
have to have support. So in other words, theyíre saying if the
patient has a chronic kidney disease and they have hypertension, youíre 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 forÖ is the main code for chronic kidney disease. Okay so thatís what theyíre saying that
if your patient has hypertension and chronic kidney disease, youíre not going to use a
401 code. Youíre going to use a 403 code and then youíre
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 itís hypertensive
heart disease you know, it has to say due to or all that terminology to link it, you
donít have to do that with CKD. Okay, the appropriate code, 585 is for chronic
kidney disease and it is aÖ it should be your secondary. So when you get into the primary and the secondaryÖ
so letís 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 donít have to memorize it. So youíll use the 403 to identify that itís
hypertensive. The CKD unspecified includes these things:
chronic renal disease, chronic renal failure ñ not otherwise specified or chronic renal
insufficiency. That all means CKD. Okay so as youíre going through terminology
and your anatomy and physiology courses and stuff like that then youíll start seeing
these other terms and youíll know thatís all chronic kidney disease. Itís 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. ThatísÖ but your guidelines tell you that
in the book so you donít have to worry about memorizing that. So hereís 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 itís 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 thereís 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, thatís not all the question. But letís 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. Heís got chronic kidney disease stage 3 which
is 585.3. You donít have to guess, I told you thatís
the right answer. But what are we going to do with the hypertension? Youíve got 401.1 which is benign, 401.9 which
is essential, 403.90 which isÖ I have to see the hypertensive table to see what itís
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, weíll show
you that. Laureen: Do you see it? Alicia: The hypertension table? Do you have it? Laureen: I did. Oh you donít maybe because the pollís going
on. You canít see it. Alicia: Oh yeah. So if I give you that information, real quick,
which one do you think that youíre 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 oneís taking a little time, huh? Alicia: Yeah, just guess. Boyd: 50% voted now. Alicia: Thatís probably good. Boyd: 62, okay great. Iím going to go and close it in 3, 2, 1Ö
70% voted. Great, guys. Thank you. And closing the poll and showing the poll. Alicia: Youíre 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 youíre not going to use the 401.1 because
thatís benign and 401.9 is unspecified. But when you use your hypertension table which
is in the middle of the index under the Hís, itís before your poison control table, itís
going to tell you that if your person has hypertension and then theyÖ it says ìwith
chronic kidney diseaseî youíre 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 youíre going to scroll down until you
findÖ oh right there, with chronic kidney disease. You know your person has stage 3 so 1 through
4 or unspecified. So thereís your choices, 403.00, 403.10 and
403.90. Oh, doesnít Laureenís nails look nice. And since benign was not mentioned, you cannot
use the 403.00 and the 403.10. It is unspecified, 403.90.

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