Chapter 9: Diseases of the Circulatory System

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Questions and Answers

Which category is used to assign codes for hypertension with heart disease?

I00-I99

I11 (correct)

I50

I51

When documenting hypertension with heart conditions, which additional category should be used to identify the type(s) of heart failure in patients with heart failure?

I51

I00-I99

I50 (correct)

I11

In the absence of explicit documentation stating that hypertension is related to heart or kidney involvement, how should these conditions be coded?

As related (correct)

Not coded

Separately

Under I00-I99

Which conditions must have explicit provider documentation linking them in order to be coded as related to hypertension?

Conditions not specifically linked Signup and view all the answers

If the provider documents that heart conditions are unrelated to hypertension, how are they coded?

Separately from hypertension Signup and view all the answers

Which code is used to represent a type 1 non-ST elevation myocardial infarction (NSTEMI)?

I21.4 Signup and view all the answers

If a type 1 STEMI converts to NSTEMI due to thrombolytic therapy, how should it be coded?

Code the STEMI Signup and view all the answers

What code should be used for a subsequent myocardial infarction of a different type than the initial myocardial infarction?

No additional code should be used Signup and view all the answers

How should an AMI documented as nontransmural or subendocardial, but with the site provided, be coded?

As a subendocardial AMI with the site Signup and view all the answers

Which code should be used for a type 2 myocardial infarction (myocardial infarction due to demand ischemia)?

I21.A1 Signup and view all the answers

What is the default code for an unspecified acute myocardial infarction?

I21.9 Signup and view all the answers

Which codes should be used for subsequent myocardial infarctions within 4 weeks of the initial myocardial infarction?

Codes from both categories I22 and I21 Signup and view all the answers

How should a type 1 NSTEMI that evolves to a STEMI be coded?

Code the subsequent STEMI Signup and view all the answers

What code should be used for old or healed myocardial infarctions not requiring further care?

I25.2 Signup and view all the answers

Which codes should be used for acute myocardial infarctions types 3, 4a, 4b, 4c and 5?

I21.A9 Signup and view all the answers

What is the correct coding approach for a patient with hypertensive chronic kidney disease and acute renal failure?

Code hypertensive chronic kidney disease along with acute renal failure Signup and view all the answers

For a patient with hypertensive heart and chronic kidney disease, what coding approach should be followed if heart failure is present?

Assign an additional code from category I50 to identify the type of heart failure Signup and view all the answers

What would be the correct coding sequence for a case of hypertensive cerebrovascular disease?

Assign the appropriate code from categories I60-I69 first, followed by the appropriate hypertension code Signup and view all the answers

How should secondary hypertension be coded?

Assign one code to identify both hypertension and the underlying etiology Signup and view all the answers

What would be the appropriate coding choice for a patient with transient hypertension during pregnancy?

Code elevated blood pressure reading without diagnosis of hypertension Signup and view all the answers

How should a case of controlled hypertension usually be coded?

Assign appropriate codes from categories I10-I15 Signup and view all the answers

What coding approach should be followed for uncontrolled hypertension?

Assign codes from categories I10-I15 despite unresponsiveness to current therapy Signup and view all the answers

How should hypertensive crisis be coded?

Use a single code to identify both hypertensive crisis and any identified hypertensive disease Signup and view all the answers

What is the appropriate coding guideline for hypetertensive retinopathy?

Combine a code from subcategory H35.0 with a code from categories I10-I15 Signup and view all the answers

In which scenario should an additional code from category N18 be used when coding for hypertensive chronic kidney disease?

When the CKD is not related to hypertension Signup and view all the answers

What is the primary purpose of coding hypertension with code I10 (Essential hypertension) in ICD-10-CM?

To classify the type and severity of the hypertension Signup and view all the answers

When should the code I13.0 (Resistant hypertension) be assigned as an additional code?

When the provider specifically documents "resistant hypertension" Signup and view all the answers

Which code combination should be used for a patient with atherosclerotic heart disease of native coronary artery and angina pectoris?

I25.11 (Atherosclerotic heart disease of native coronary artery with angina pectoris) Signup and view all the answers

When a patient with coronary artery disease is admitted due to an acute myocardial infarction (AMI), which condition should be sequenced first?

The AMI Signup and view all the answers

Which type of cerebrovascular accident requires specific documentation of the cause-and-effect relationship with a medical intervention?

Both intraoperative and postprocedural cerebrovascular accidents Signup and view all the answers

What is the purpose of category I69 (Sequelae of Cerebrovascular disease) in ICD-10-CM?

To code neurologic deficits that persist after the initial onset of a cerebrovascular disease Signup and view all the answers

How should the affected side be coded when a patient with hemiplegia or hemiparesis has the affected side documented, but it is not specified as dominant or non-dominant?

For ambidextrous patients, code the affected side as dominant; otherwise, code as non-dominant for left side, dominant for right side Signup and view all the answers

When can codes from category I69 (Sequelae of Cerebrovascular disease) be assigned with codes from categories I60-I67 (Cerebrovascular diseases)?

When the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease Signup and view all the answers

Study Notes

Coding for Hypertension and Heart Disease

Codes for hypertension associated with heart disease are assigned under "I13" category.
For heart conditions related to hypertension, additional codes representing the type(s) of heart failure, such as I50, should be included.

Coding Guidelines in Absence of Documentation

In the absence of explicit documentation linking hypertension to heart or kidney involvement, do not code them as related.
Explicit provider documentation is required to code conditions such as left ventricular hypertrophy or hypertensive heart disease as related to hypertension.

If a provider states heart conditions are unrelated to hypertension, code them independently, such as for heart disease or heart failure.
Type 1 non-ST elevation myocardial infarction (NSTEMI) is coded using I21.4.

Coding STEMI and NSTEMI

If a type 1 STEMI converts to NSTEMI due to thrombolytic therapy, the initial STEMI code (I21.9) is retained as per coding guidelines.
Use I21.3 to code a subsequent myocardial infarction of a different type from the initial one.
Documented nontransmural or subendocardial AMI with site details should use the appropriate AMI code from I21 series indicating the site.

Special Cases of Myocardial Infarction

For type 2 myocardial infarction, use code I21.9.
The default code for unspecified acute myocardial infarction is I21.9.
For subsequent myocardial infarctions within four weeks of the initial event, use I22 codes.

Progression from NSTEMI to STEMI

Code a type 1 NSTEMI that evolves to a STEMI with the STEMI code (I21.9).
Use I25.2 for old or healed myocardial infarctions not requiring further care.

Coding for Specific Myocardial Infarctions

Acute myocardial infarctions types 3, 4a, 4b, 4c, and 5 have specific codes in the I21-I22 range and should be coded based on documentation.
For hypertensive chronic kidney disease with acute renal failure, use codes for both conditions if documented.
In cases of hypertensive heart and chronic kidney disease with heart failure, code each condition sequentially based on severity.

Coding for Hypertensive Cerebrovascular Disease

The coding sequence for hypertensive cerebrovascular disease should prioritize the hypertension code (I10) followed by cerebrovascular disease.
Secondary hypertension requires specific coding, typically starting with the underlying condition contributing to hypertension.

Coding for Pregnancy and Hypertension

Transient hypertension during pregnancy is coded using O26.8 as a complication of pregnancy.
Controlled hypertension should use I10, while uncontrolled hypertension is referenced by using I11.

Coding for Hypertensive Crisis

Hypertensive crisis should be coded under I16 with specific notations if applicable.
Hypertensive retinopathy coding follows guidelines that require the use of additional codes to indicate any related conditions.

Coding for Chronic Kidney Disease

An additional code from category N18 is used when documenting hypertensive chronic kidney disease if stage is specified.
The essential purpose of coding hypertension with I10 is to establish a primary diagnosis in ICD-10-CM.

Resistant Hypertension and Atherosclerosis

Assign code I13.0 (Resistant hypertension) as an additional code when detailed conditions outlined are resistant.
A code combination for a patient with atherosclerotic heart disease and angina pectoris is I25.110 and I20.9.

Coding for Acute Myocardial Infarction and Conditions

For acute myocardial infarction, the specific condition leading to admission must be prioritized, especially if related to coronary artery disease.
Specific documentation of the cause and effect is required for some cerebrovascular accidents when coding medical interventions.

Sequelae of Cerebrovascular Disease

Use category I69 to document sequelae related to cerebrovascular disease.
When hemiplegia or hemiparesis is documented without specification of dominant or non-dominant, code it as affected but not distinguishing.

Concurrent Coding with I69 and Cerebrovascular Diseases

Codes from category I69 may be assigned with I60-I67 if relevant conditions are concurrently documented.

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Description

Learn about the classification guidelines for hypertension and its relationship with heart and kidney involvement in the context of diseases of the circulatory system. Understand how to code related conditions even without explicit provider documentation.

Chapter 9: Diseases of the Circulatory System - Hypertension Classification