The Complete Diagnosis Coding

Bookby

Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA

Chapter 4Chapter 4

Coding Circulatory ConditionsCoding Circulatory Conditions

Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved

McGraw Hill/Irwin

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.

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Learning Outcomes

· Identify manifestations that must be coded

separately.

· Distinguish coding guidelines for

cardiovascular accidents.

· Apply the guidelines correctly to code a

stroke.

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Introduction

· Circulatory conditions, such as

hypertension, are systemic. They affect

the entire body.

· Circulatory conditions are almost always

coded.

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Hypotension

Patient’s blood pressure is lower than

normal:

· Can cause a lack of oxygen

· Common symptoms: lightheadedness and

dizziness

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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

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Elevated Blood Pressure

A temporary or occasional increase in the

patient’s blood pressure:

· May be caused by nervousness, caffeine,

or stress

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Hypertension

· Hypertension may be uncontrolled or

controlled.

· Controlled hypertension is successfully

being treated.

· Either diagnosis does not affect the code

assignment.

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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

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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.

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Hypertension + Heart

· Code 402.x:

· Heart condition DUE TO

hypertension

· HYPERTENSIVE heart condition· One code only

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Hypertension + Heart

· Code 401.x + heart code:

· Heart condition WITH hypertension

· Code heart code + 402.xx:

· Heart failure DUE TO hypertension

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Hypertension + Kidney

· Code 403.xx + second code:

· Fifth digit identifies the stage of chronic

kidney disease.

· Second code reports specific stage of

kidney disease.

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Hypertension + Heart + Kidney

Code 404.xx:

· + Code for heart failure

· + Code for stage of kidney disease

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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.

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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.

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Hypertensive Retinopathy

Two codes will be required:

· 362.11 Hypertensive retinopathy

· + Hypertension code

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Hypertensive Cerebrovascular Disease

Two codes are required:

· 430–438 Cerebrovascular disease

· + Hypertension code

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Cerebrovascular Issues

· Cerebrovascular accident (CVA)

· Stroke

· Cerebral infarction

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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.

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