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Chapter 5

Chapter 5 . Hypertension and Cardiovascular. ICD-9-CM, Chapter 7—Diseases of Circulatory System. Three types of hypertension: Malignant — accelerated Benign — continuous, mild (BP  ) controllable, no irreversible vascular changes

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Chapter 5

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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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