Posts tagged ‘401.1’

July 9, 2012

401.9 is still valid … just not case-mix

I recently received a query on hypertension codes. A client was saying that 401.9 and 401.0 are no longer legitimate, as of January 2012, but coding books ordered after that have these codes.

My response is below:

The coding manual is correct. The codes are valid codes. The coding guidelines have not changed on using 401.9 and 401.1. If the patient has hypertension and there is 1) no stated or implied relationship documented by the physician between the hypertension and heart failure and 2) no chronic kidney disease or renal sclerosis, then the 401 category is correct for hypertension.

Furthermore, if the 401 category is correct (as is usual), then 4th digit 9 (unspecified) is usually correct because the physician doesn’t specify benign or malignant.

What did change is the case-mix status of 401.9 and 401.1. Those two codes are no longer case mix meaning they do not earn points. But alas, do not be discouraged. Many patients who have hypertension also have CAD, chronic ischemia, heart failure or the like, and those diagnoses earn the same points that 401.9 and 401.1 used to earn.

Continue to code hypertension when it is pertinent to your POC. The codes ARE allowed. What is important is to NOT change the code you use for HTN just to get points. CMS is looking for that type of behavior.

The coding manuals were published prior to the final rule from CMS on case-mix status so all you’ll need to do to update your manual is to write “NO $” next to those two codes.


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November 14, 2011

Jan. 1 M0090 date is the end for case-mix hypertension

CMS has clarified that payment changes relative to the removal of the hypertension codes will be effective with M0090 dates of 1/1/2012.

“Beginning with M0090 dates of January 1, 2012, 401.1 Benign essential hypertension codes and 401.9 Unspecified essential hypertension are removed from the HH PPS case-mix system. Specifically, 401.1 and 401.9 diagnosis codes will no longer result in additional points when computing the HIPPS codes”

Providers should not change the codes they use for hypertension unless they have been coding the 401 codes in error. Changing the codes just to get points is upcoding and we certainly do not want to prove CMS correct about case mix creep. You can be sure that they will be watching for trends in hypertension coding as a result of the case mix change.

Remember hypertension with chronic kidney disease (585) or renal sclerosis (587) changes the hypertension code to the 403 category. There is a presumed relationship between CKD and HTN with HTN causing the CKD.

However, a relationship between heart disease and HTN cannot be presumed. The physician must either state (e.g., heart failure due to hypertension) or imply the relationship (e.g., hypertensive heart disease).

Even if you do not have the information to be able to change the hypertension code to some other category besides 401, do not despair! Remember that hypertension and heart disease are together in Table 4. Even if you do not earn points with the hypertension codes, think how many of your patients with 401 codes also have codes from the 414 category (coronary atherosclerosis and chronic ischemia), 410 (acute myocardial infarction) and 428 (heart failure). Those codes are case mix, too, so you will not be losing any points!

Grouper information!

July 5, 2011

Hypertension gets tha axe in proposed rule

The calendar year 2012 home health proposed rule is proposing a few changes that could greatly affect payment to HHAs:

  • 401.1 and 401.9 may be removed from the case-mix list. CMS has done a series of analyses on use of the codes and resource use. The agency proposes removing these to more accurately align resources and payment use.
  • Lowering payments on high therapy episodes
  • Adjusting case-mix weights

More to come soon …

November 10, 2010

401.9 is not the only HTN code

I recently received a stressed email from a clinician confused about the use of 401.9. A doctor told her he wanted her to use 401.1, benign hypertension, rather than 401.9, which is hypertension NOS, for a patient. The clinician then tried to use 403.9, which software rejected, when coding unspecified hypertensive renal disease.

The correct coding lies in documentation. 401.9 can be used if the doctor does not specify whether the HTN is benign or malignant. If you have documented benign hypertension, and the hypertension is not linked to chronic kidney disease or heart disease, code 401.1.
Categories 402 and 403 deal with hypertension in combination with other diseases. 402.1x deals with benign hypertensive heart disease (the fifth digit indicates whether there is heart failure), and 403.1 addresses benign hypertensive chronic kidney disease. Don’t forget to add the stage of kidney disease after the 403 code.

If the patient has HTN and CKD, the hypertension is automatically considered hypertensive chronic kidney disease and is coded with a code from the 403 category. The 403 codes require 5 digits, but you coded with four digits, and that is why your software wouldn’t accept 403.9.

Always, always check the highest specificity to make sure your codes are valid. Query your docs for more specific disease information.

July 17, 2010

HTN on the case-mix chopping block

A part of the HHPPS payment adjustment for 2011 includes a proposal to remove 401.9, Unspecified Essential Hypertension, and 401.1, Benign Essential Hypertension, from the case-mix list because an analysis shows that patients with these diagnoses don’t use more resources than other patients. This is a huge change, as HTN is an accepted comorbidity that is always coded because it can influence a patient’s health and resource usage.

Read more in the document here, and keep looking on this blog for more news as I review the whole document and post more information.

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