Posts tagged ‘416.0’

November 29, 2010

A comorbidity quandry? No, look at treatment and patient health

I continue to receive questions on hypertension (401.9) and pulmonary hypertension (416.0). One reader recently asked if I would consider pulmonary hypertension to be a comorbidity that should always be coded.

Remember that the list of comorbidities “that should always be coded” are examples of diagnoses likely to impact care because of the chronicity. When you code a comorbidity … a condition that affects the patient’s health, or is such an impactful disease that even if it is under control can affect the patient’s health detrimentally and quickly … that you must think about the treatment aspect.

Is pulmonary hypertension under treatment with medications, education, or intervention? Yes, code it. Does pulmonary hypertension have the potential of impacting other conditions? Probably, but remember that CMS requires that comorbidities be addressed in the POC, so what are you doing about the pulmonary hypertension?

Keep in mind that “chronic” does not automatically mean that a disease is a comorbidity. GERD (530.81) is a great example. A patient may have chronic GERD, but if medication has taken care of symptoms for a length of time, what justifies its “status” as a comorbidity? It’s not being treated by home health professionals. There aren’t interventions.

I love this question … someone is thinking on their feet!

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October 6, 2010

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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August 12, 2010

2011 code thoughts

Go to the Musings of a Code-a-holic page to see my thoughts on the Oct. 1 changes!