Posts tagged ‘401.9’

November 11, 2012

Once again: 401.9 is a valid code

I have received another email from someone who attended my class asking me to verify that 401.9 is a valid code … others at her agency are telling her that it is not a valid hypertension code.

It is. 401.9 is valid. It is a useful code and one that you may have to use, depending on documentation.

401.9 is a valid code and is the correct code for HTN when no other information is available. It would be upcoding to change your hypertension code if you did not have additional information. There are many codes that we use that do not provide points, and this code is no longer case-mix. We must code according to the patient’s condition and the coding guidelines regardless whether the code is case-mix. Remember that if the patient has a heart condition, such as acute MI, chronic insufficiency, CAD or heart failure, then you’ve still earned those points that used to be awarded for 401.9.

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 …

December 2, 2010

401.9 … still a valid code?

I recently received this queston, and the answer is: Of course it is!

401.9, essential hypertension, is on the 2011 code list, and it is valid.

I’m sure the real question surrounds its case mix status.

As this blog noted a few months ago, 401.9 was under review to be taken off the case mix list. The code still is case mix, but that doesn’t mean it will stay as such permanently.

It comes down to this: the code is valid, and we code based on patient care, not on case mix.