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Family Practice Coding Alert

Accurate Diagnosis Coding is Key to Reporting Hypertension Services

Many family practices report that diagnosis coding for hypertension can be problematic because chart notes often dont provide adequate specificity. When assigning codes, professional coders are required to distinguish between malignant, benign and unspecified hypertension. If the proper distinction is not made, third-party payers may reject the accompanying procedure codes describing physical exams or diagnostic tests because certain services are approved only with malignant (401.0) or benign (401.1) essential hypertension, but not for unspecified (401.9) essential hypertension.

The fundamental problem arises when a physician merely notes hypertension on the chart, leaving coders unsure of a precise diagnosis. Even reviewing the patient chart more closely may not provide coders with adequate information because there is confusion about which clinical terms apply to which types of hypertension, says Paula Casto, CPC, billing supervisor for a physician practice in Irving, Texas. When coders are unsure, they often assign the unspecified code, which may not be appropriate.

To solve this problem, coders must understand these diagnostic codes and educate practice physicians about the importance of using the ICD-9 definitions when diagnosing hypertension.

Malignant vs. Benign vs. Unspecified Hypertension

The diagnosis codes most often assigned for hypertension (401.x) are classified as essential hypertension, which means the cause for the condition is unknown. Many additional hypertensive conditions in the ICD-9 manual are not considered essential because they are a secondary symptom of another disease (i.e., 403.x, hypertensive renal disease) and the physician can pinpoint what caused the hypertension.

Malignant hypertension is clinically defined as accelerated hypertension with papilledema (edema of the optic disk) and indicates an urgent situation, according to Colleen King, RN, practice administrator for Worthington Industrial Medical Center in Columbus, Ohio. The patients blood pressure has risen rapidly to very high levels, 230 or 240 over 130, for instance, she says. It demands immediate attention because it indicates a critical condition. If malignant hypertension is not controlled, patients may experience organ damage in the retina, kidneys and brain. Untreated, the illness two-year survival rate is lower than 50 percent.

On the other hand, benign essential hypertension is characterized by a more moderate elevation in blood pressure that may happen gradually. In addition, no symptoms of contributing diseases are present. This form of hypertension comprises 90 to 95 percent of all cases, and is the type most frequently treated by family physicians.

Many healthcare professionals regard unspecified as a coding term, rather than a medical term, and indicate it is used only when there is not enough clinical information to categorize the disease as malignant or benign. Coders should avoid using the unspecified [...]