Posted on Monday, February 6, 2017 6:37 PM
Homecare coders seem to still have trouble understanding the new coding guidance concerning hypertension and CKD. Hypertension doesn’t get much attention compared to diabetes, but it has also gone through some changes due to the convention “with,” as well as a small change to the wording of the guidance. The guideline supporting this change is full of specific instructions to help take the guessing out of coding hypertension as well as its related conditions.
In Chapter 9, Diseases of the Circulatory System (I00-I99), you can see the following guidance: 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 or code title. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states that the conditions are unrelated. For hypertension and conditions not specifically linked by relational terms such as “with,” “associated with,” or “due to” in the classification, provider documentation must link the conditions in order to code them as related.
What some people fail to notice is that the assumed relationship hypertension and CKD had in ICD-9 has now changed. Before, you assumed these two were related even if another cause was stated. As of October 2016, if another cause is stated for the CKD, then it should not be coded as related to hypertension. You need to pay close attention to your documentation and look for a documented cause for the condition. Once the cause is stated no assumption can be made.
Written by Mary Deakle, BCHH-C, COS-C, Corridor’s Senior Manager of Compliance and Education.
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