Excludes notes not always what it seems

I’ve had several questions on whether HTN (401.9) and pulmonary hypertension (416.0) are exclusive of each other.

They are two separate diagnoses, and pulmonary hypertension has its own subspecialty in the pulmonary field, but an Excludes note at Category 401, Essential Hypertension, has caused some confusion, as pulmonary hypertension (416.0-46.9) is excluded from coding with 401.

Is it really?

Remember that exclusion notes can have two different meanings. This difference will all be clear when we move to ICD-10 and the Excludes notes are numbered ‘1’ or ‘2’, but in the meantime we just struggle through!

The Excludes note under hypertension that excludes pulmonary hypertension actually indicates that the condition identified in the note is not part of the condition represented by the code where the note appears. The note is saying that 416.0-416.9 is not part of the 401 code set, even though they’re both hypertension diagnoses, so both codes may be reported together if the patient has both conditions.

This scenario is much, much different than coding CHF (428.0) and fluid overload (276.6) together, for example. As even beginning coders know, these codes cannot be coded together, as the Excludes note at 428.0 tells us. But how do we know that’s a true exclusion? Because fluid overload is always integral to CHF, not an independent diagnosis, and you do not code integral symptoms with its disease. With the hypertension scenario, they are separate diagnoses that would be confirmed by doctors, not interdependent diagnoses.

Learn more about pulmonary hypertension.

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One Comment to “Excludes notes not always what it seems”

  1. good information. in addition to that the question is always asked whether you code ckd with pulmonary htn and need a 403 code also. the answer is no. essential hypertension and ckd are assumed related to each other but there is no assumed relation between pulmonary htn and ckd.

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