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Understanding Hypertension and Its Cardiovascular Implications in ICD-9-CM Classification

This chapter focuses on the classification of hypertension and related cardiovascular conditions within the ICD-9-CM framework. It details the three types of hypertension: malignant, benign, and unspecified, and how to code them accurately. It explains the relationship between hypertension and heart disease, chronic kidney disease, and cerebrovascular conditions, providing guidelines for proper coding. Additionally, it outlines how to address cases of controlled and uncontrolled hypertension, as well as the implications of transient episodes.

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Understanding Hypertension and Its Cardiovascular Implications in ICD-9-CM Classification

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  1. Chapter 5 Hypertension and Cardiovascular

  2. ICD-9-CM, Chapter 7—Diseases of Circulatory System • Three types of hypertension: • Malignant—accelerated • Benign—continuous, mild (BP) controllable, no irreversible vascular changes • Unspecified—NOT indicated as either malignant or benign (.9) • Hypertension table located in Indexof ICD-9-CM • Under “H”, Hypertension • Locate now

  3. Section I.C.7.a.1. Hypertension, Essential, or NOS • Assign hypertension • arterial • essential • primary • systemic • NOS to 401 • Fourth digit to indicate type, 401.X

  4. Section I.C.7.a.2. Hypertension With Heart Disease • 402 Category • Certain heart conditions when stated “due to hypertension” or implied (“hypertensive”) • Addfourth digit for type • Use additional code to specify type of heart failure (428)

  5. Section I.C.7.a.3. Hypertensive Chronic Kidney Disease • Cause-and-effect relationship assumed in chronic kidney disease with hypertension • Category 403, Hypertensive chronic kidney disease, used when following present: • Chronic kidney disease (585.X) • With 403 assign fifth digit 0 stage I-IV or unspecified and 1 for stage V or end stage renal disease

  6. Section I.C.7.a.4. Hypertensive Heart and Chronic Kidney Disease • Assign 404 when both hypertensive chronic kidney disease and hypertensive heart disease stated • Assume cause-and-effect relationship • Assign fifth digit for mention of kidney, heart failure, and/or stages I-IV or end stage renal disease • Use additional code from category 428, identifying type of heart disease

  7. Stages of Chronic Kidney Disease • Stage I: Blood flow through kidney increases, kidney enlarges (585.1) • Stage II: (mild) Small amounts of blood protein (albumin) leaks into urine (microalbuminuria) (585.2) • Stage III: (moderate) Albumin and other protein losses increase. Patient may develop high BP and kidney’s filter ability (585.3) • Stage IV: (severe) Large amounts of urine pass through kidney, blood pressure increases (585.4) • Stage V: Ability to filter waste nearly stops (585.5) • End stage renal failure (585.6) • When documentation indicates chronic renal disease (CKD) and ESRD, report ESRD • Unspecified 585.9

  8. Section I.C.7.a.5. Hypertensive Cerebrovascular Disease Code: • Cerebrovascular disease (430-438) first • Type of hypertension (401-405) second

  9. Section I.C.7.a.6. Hypertensive Retinopathy Code: • Hypertensive retinopathy first (362.11) • Type of hypertension (401-405) second

  10. Section I.C.7.a.7. Hypertension, Secondary • Hypertension caused by an underlying condition • Code: • Underlying condition first • Type of hypertension (405) second

  11. Section I.C.7.a.8. Hypertension, Transient • Transient hypertension: Temporary elevation of BP • DO NOT assign 401-405 Hypertensive Disease • Hypertension diagnosis NOT established • Instead use: • 796.2, Elevated blood pressure • 642.3X, Transient hypertension of pregnancy

  12. Section I.C.7.a.9. Hypertension, Controlled • Hypertension controlled by therapy • Assign code from 401-405

  13. Section I.C.7.a.10. Hypertension, Uncontrolled • Untreated hypertension • Uncontrolled hypertension • Assign code from 401-405

  14. Section I.C.7.a.11. Elevated Blood Pressure • Elevated blood pressure coded 796.2 • Elevated BP reading without hypertension is diagnosis • Hypertension NOT stated, NOT coded to 401 (essential hypertension)

  15. ICD-9-CM, Chapter 7—Diseases of Circulatory System • Code 410 Acute Myocardial Infarction (MI) requires a fifth digit: “1” Initial episode of care for MI • May be reported by more than one facility, if patient transferred “2” Subsequent care • Patient re-admitted for testing/treatment within the first eight (8) weeks of initial episode • Code 412 reported for old/healed MI • No symptoms

  16. Section I.C.7.d. Late Effects of Cerebrovascular Disease • 438 indicates conditions classified to 430-437 as causes of Late Effects • Code V12.54 • Assigned for TIA and cerebral infarction without residual deficits • Do not report from category 438

  17. ICD-9 Chapter 5 Hypertension and Cardiovascular

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