1. The Complete Diagnosis Coding Book by Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA Chapter 4 Coding Circulatory Conditions Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved McGraw Hill/Irwin

2. Learning Outcomes ·Interpret the difference between elevated blood pressure and hypertension. ·Correctly evaluate the hypertension table in the alphabetic index. ·Determine the level of hypertension to be coded. 4 - 2

3. Learning Outcomes ·Identify manifestations that must be coded separately. ·Distinguish coding guidelines for cardiovascular accidents. ·Apply the guidelines correctly to code a stroke. 4 - 3

4. Introduction ·Circulatory conditions, such as hypertension, are systemic. They affect the entire body. ·Circulatory conditions are almost always coded. 4 - 4

5. Hypotension Patient’s blood pressure is lower than normal: ·Can cause a lack of oxygen ·Common symptoms: lightheadedness and dizziness 4 - 5

6. Hypertension Patient’s blood pressure is consistently too high: ·Can cause damage to organs, especially heart and kidneys ·Must be specifically diagnosed by the physician 4 - 6

7. Elevated Blood Pressure A temporary or occasional increase in the patient’s blood pressure: ·May be caused by nervousness, caffeine, or stress 4 - 7

8. Hypertension ·Hypertension may be uncontrolled or controlled. ·Controlled hypertension is successfully being treated. ·Either diagnosis does not affect the code assignment. 4 - 8

9. Hypertension Malignant: Very unusual; extremely high blood pressure accompanied by papilledema, organ damage, and so on Benign: More common; typically controlled with diet and medication Unspecified: Not stated in documentation whether the condition is malignant or benign 4 - 9

10. Essential Hypertension ·This is the most common type of hypertension. ·Use code 401 with the appropriate fourth digit. ·ALL hypertension codes require at least four digits. 4 - 10

11. Hypertension + Heart ·Code 402.x: ·Heart condition DUE TO hypertension ·HYPERTENSIVE heart condition ·One code only 4 - 11

12. Hypertension + Heart ·Code 401.x + heart code: ·Heart condition WITH hypertension ·Code heart code + 402.xx: ·Heart failure DUE TO hypertension 4 - 12

13. Hypertension + Kidney ·Code 403.xx + second code: ·Fifth digit identifies the stage of chronic kidney disease. ·Second code reports specific stage of kidney disease. 4 - 13

14. Hypertension + Heart + Kidney Code 404.xx: ·+ Code for heart failure ·+ Code for stage of kidney disease 4 - 14

15. Secondary Hypertension + Code 405.xx: ·First, list the underlying condition, that is, the disease that caused the patient to have hypertension. ·Second, list code 405.xx. 4 - 15

16. Hypertension + Pregnancy Gestational hypertension 642.3x: ·Diagnosis of hypertension existed prior to the beginning of the pregnancy; code 401.x if no impact on mother’s condition. 4 - 16

17. Hypertensive Retinopathy Two codes will be required: ·362.11 Hypertensive retinopathy ·+ Hypertension code 4 - 17

18. Hypertensive Cerebrovascular Disease Two codes are required: ·430–438 Cerebrovascular disease ·+ Hypertension code 4 - 18

19. Cerebrovascular Issues ·Cerebrovascular accident (CVA) ·Stroke ·Cerebral infarction 4 - 19

20. Chapter Summary ·Circulatory conditions such as hypertension can be very complex due to their effect on the entire body. ·Ensure that the documentation is complete. 4 - 20