Ch 12 CM- Cardiovascular DX's

Coding Diagnoses in the Cardiovascular System

Hypertension and it's coding complexities

Cerebrovascular Accidents

Myocardial Infarctions

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

​Is HTN
HBP?

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

Hypertensive Heart Disease
HTHD

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

Hypertensive Chronic
Kidney Disease
HTKD or HTCKD

Double Whammy

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

Hypertensive Cerebrovascular Disease and Retinopathy

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

More Guidelines

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

and more Guidelines

Atherosclerotic Coronary Artery Disease (AKA CAD)

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

​If CAD and MI, the MI gets coded first

Intraoperative/Postprocedural CVA's

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)

Myocardial Infarctions (aka?) MI, AMI, Old MI

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

​<= 4 weeks - active
> 4 weeks aftercare or OLD

Fill in the Blank

HTHD with heart failure

.

,

.

Fill in the Blank

Hypertensive Emergency in patient with essential hypertension

.

,

Fill in the Blank

CAD (coronary artery disease) of multiple native arteries

due to lipid rich plaque of one coronary artery

without angina pectoris

.

,

.

Fill in the Blank

You may need to revisit your guidelines/read tabular notes carefully:

A patient was admitted for a second STEMI

of the anterior wall, two weeks after

being hospitalized for a STEMI of the

anterior wall that was also treated during

the same admission.

.

,

.

Fill in the Blank

cerebral infarction due to middle cerebral artery

with dysphagia that was a sequela from a previous stroke

.

,

.

Fill in the Blank

ESRD with HTN

.

,

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