Posts tagged ‘htn’

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!

June 13, 2011

Doozie of a coding case

Question: We have a doozie of a patient.
He was discharged from an inpatient stay at the hospital for abscess under the right axilla for which he had an I&D.  We are seeing him for wound care following this procedure.  The wound is clean now without any infection presently.  He also had a pulmonary embolism that was treated in the hospital with lovenox and Coumadin.  He is still on Coumadin, of course, and this affects his dressing changes as he bleeds quite a bit during the dressing changes. Plus we will be monitoring his PT/INRs of course. He also has LE DVT.

The primary reason that we are seeing him is the wound care.

He is a type 2 diabetic (fairly recently diagnosed) and just started on Levamir while in the hospital. This may delay wound healing, so I know that it needs to be pretty up in the diagnosis chain.

Past history includes CA of the appendix (which has been removed surgically), but this metastasized to the abdomen (does not give specific organ, but I am assuming colon because he has a colostomy) and the lung. He is independent with his colostomy, so I know not to code “ATTN TO” on this one. He also has hx of prostate CA as well.

His cancer is still active as he is on chemotherapy.  It is just on hold related to the fact that he had the abscess.

He is morbidly obese, has HTN (with several meds) and GERD.

I am in desperate need of assistance on this one.

Lisa says: He’s a doozie all right!! I think I would still code the wound as an abscess. Follow with the PE, DVT, diabetes, HTN, secondary site(s) of Ca. Follow with V58.83, V58,61, V44.3 and the rest of the codes. Once you’ve coded the primary, you just have to consider the seriousness of the other conditions and importance to the POC. Push your V codes to the bottom.

March 27, 2011

Coding Clinic tackles HTN and renal sclerosis coding

These Q&As come from the Coding Clinic, Fourth Quarter 2010 Page: 137 Coding advice or code assignments contained in this issue effective with discharges October 1, 2010.

A patient seen in the physician’s office was diagnosed with renal sclerosis due to hypertension. I understand that this should be coded with a code from category 403, Hypertensive chronic kidney disease, but I’m unable to determine what 5th digit should be applied. Please provide some clarification.
Assign code 403.90, Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified. The fifth digit of “0” should be assigned since there is no chronic kidney disease stage specified. In addition, assign also code 587, Renal sclerosis, unspecified.

A patient with renal sclerosis due to hypertension and stage V chronic kidney disease (CKD) is seen in the doctor’s office. How should this be coded?
Assign code Assign code 403.91, Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; code 587, Renal sclerosis, unspecified; and code 585.5, Chronic kidney disease, stage V, for a patient with hypertension due to renal sclerosis and stage V CKD. The fifth digit for subcategory 403.9 is selected on the basis of the documented CKD stage.

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