ARE YOUR CODERS MAKING ASSUMPTIONS THEY SHOULDN’T BE MAKING?
AUGUST 29, 2018
Coders have been taught to assume a relationship between HTN and heart failure and HTN and CKD if both diagnoses are documented by the physician. But there are times when that assumption should not be made.
Section I.C.9.a. of the ICD-10 Coding Guidance states:
The classification presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement, as the two conditions are linked by the term “with” in the Alphabetic Index. These conditions should be coded as related even in the absence of provider documentation explicitly linking them unless the documentation clearly states the conditions are unrelated.
Many coders are failing to look for documentation that would make these conditions unrelated, but rather just automatically link the two if they are documented by the provider. If the two diagnoses are presumed as related, the HTN code changes from I10 to either I11.x with CHF, or I12.x with CKD, or I13.xx with both CHF and CKD. But if the HTN is caused by something else, it would be coded as secondary HTN I15.XX
Coders need to check the provider documentation carefully for indications that the HTN is due to something besides the CHF or CKD. For instance, physician’s notes state patient has HTN secondary to Obstructive sleep apnea, and patient also has CHF. In this case, the HTN would not be presumed as related to the CHF, but rather be coded as related to OSA which is coded I15.8 Other secondary HTN followed by the OSA coded G47.33. The CHF would be coded separately I50.xx.
A careful review of the provider documentation is essential in capturing the most accurate codes for your patients.