ICD 9 Coding — Coding Hypertension and Chronic Kidney Disease
ICD 9 Coding — Coding Hypertension and Chronic Kidney Disease
ICD 9 Coding — Coding Hypertension and Chronic Kidney Disease http://go.cco.us/icd-9-cm-mini-course-yt
That’s Alicia’s. I guess I’ll bring that answer sheet up.
Alicia: Yeah. And you know what? You guys, I just took a class on this so it’s very exciting. I just feel like my little spongy brain has absorbed all kinds of information and it was a lot of fun. I’ve struggled with this too.
So hypertension, abbreviated HTN if you guys didn’t know that you know, what is hypertensive disease? And it’s so broad that you know, you can’t really define it per se. But the main thing about hypertension is you want to know is it essential or primary hypertension? Okay… and it’s going to mean, is there no underlying condition that is causing the blood pressure to increase? Okay so what percentage do you think is essential or primary hypertension? In fact, 95% is essential and unless blood pressure readings are very high, efforts to control blood pressure are usually based on things that… you can just change in your lifestyle. You know, you can lose weight. You can exercise. You can you know, reduce your salt. You know, reduce your stress. Only 10% have a secondary hypertension which would be under category 405.
So probably the first code… I always laugh because the first code that most new coders learn is 401.9 because you see it a lot especially if you’re coding for Medicare patients. Everybody seems to have hypertension. So let’s see, the physician must document if the patient’s hypertension is benign or malignant in order to get your 4th digit. Okay so if it doesn’t say whether it’s benign or malignant then you have to use 401.9 which, by the way, translates in icd 10 as I10 which I think is kind of fun. So now you already know an icd 10 code.
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• ICD 9 Coding — Coding Hypertension an…
Content
0 -> all right hypertension and chronic
2.07 -> kidney disease that's Alicia's I guess
4.56 -> I'll bring the answer sheet huh yeah and
8.309 -> you know what you guys I just took a
10.139 -> class on this so it's very exciting I
12.57 -> just feel like my little spongy brain
15.99 -> has absorbed all kinds of information
17.789 -> and it was a lot of fun I struggled with
21.539 -> us too
40.94 -> so hypertension abbreviated HTN if you
44.7 -> guys didn't know that you know what is
47.94 -> hypertensive disease and it's it's so
50.91 -> broad that you know you can't really
52.95 -> define it per se but the main thing
57.12 -> about hypertension is you want to know
58.83 -> is it essential or primary hypertension
61.489 -> okay and it's going to mean is there no
64.199 -> underlying condition that is causing the
66.72 -> blood pressure to increase okay
70.26 -> so what percentage do you think is
73.11 -> essential or primary hypertension in
75.33 -> fact ninety five percent is in central
78.6 -> and unless blood pressure readings are
81.509 -> very high efforts to control blood
83.94 -> pressure are usually based on things
85.59 -> that you can just change in your
87.18 -> lifestyle you know you can lose weight
88.59 -> you can exercise you can you know reduce
91.2 -> your salt you know reduce your stress
95.22 -> only ten percent have a secondary
98.43 -> hypertension which would be under
100.229 -> category 405 so probably the first code
104.61 -> I always laugh because the first code
106.38 -> that most new coders learn is 41.9
110.81 -> because you see it a lot especially if
114.42 -> you're coding for Medicare patients
115.89 -> everybody seems to have hypertension so
119.06 -> let's see the physician must document if
121.95 -> the patient's high partition is benign
124.74 -> or malignant in order to get your fourth
127.979 -> digit okay so if it doesn't say whether
131.37 -> it's benign or malignant then you have
134.22 -> to use for oh one point nine which by
136.62 -> the way translates in icd-10 is i-10
139.44 -> which i think is kind of fun so now you
142.2 -> already know an icd-10 code okay so what
146.22 -> would you code if you have a diagnosis
148.38 -> of elevated blood pressure without a
150.72 -> diagnosis of hypertension that's
152.579 -> something else that's actually seven
155.1 -> nine six point two which reads elevated
157.68 -> blood pressure reading without diagnosis
160.769 -> of hypertension okay what if you have an
163.26 -> encounter of elevated with elevated
164.97 -> blood pressure and in the patient's
166.95 -> tanking been a car and they refill their
169.47 -> been a car for three months you know
171.359 -> what
171.99 -> you use you're actually going to use the
174.54 -> four oh one point nine because benicar
176.58 -> is used to control hypertension so that
180.09 -> way if says elevated blood pressure
181.95 -> you're not going to use that seven nine
183.18 -> six point two they're actually treating
185.91 -> them for hypertension so you would use
187.5 -> the four oh one point nine okay we need
189.6 -> to make sure the patient has
190.92 -> hypertension from the documentation in
194.46 -> order to code the hypertension though so
197.88 -> as we scroll down these are the key ones
201.45 -> that you need to know in order to code
203.46 -> for one point one it has to say it's
207.06 -> benign hypertension in order for it to
209.85 -> be four oh one point zero it has to be
213.33 -> malignant in the documentation and if it
216 -> doesn't state whether it's benign or
217.38 -> malignant then you're going to default
219.18 -> to four oh one point nine and for you
221.52 -> new coders out there and they're just
223.8 -> starting to go through the codes if
225.6 -> something ends in a nine and icd-9 it
228.03 -> usually means it's unspecified okay
230.04 -> that's your you'll you'll notice that as
232.8 -> you want now for your chronic kidney
236.04 -> disease the CKD so some diagnoses have
241.38 -> to be supported with link you know they
245.64 -> have to link them like if you have
246.87 -> hypertension and CA D then you know they
250.29 -> have to the doctor has to specifically
251.88 -> state that they're linked for you to be
254.34 -> able to code certain codes but with
256.26 -> hypertension in CKD you don't have to
258.75 -> have support so in other words they're
260.34 -> saying if the patient has chronic kidney
262.38 -> disease and they have hypertension
263.94 -> you're going to go to your hypertensive
266.25 -> table and use those codes so as we
268.47 -> scroll down the CKD for our next page
273.11 -> assign codes from category 403
275.81 -> hypertensive chronic kidney disease when
278.31 -> conditions classified to category five
281.16 -> eight five or five eight seven or
283.08 -> present with hypertension now that may
285.06 -> sound kind of scary to new coders but
286.59 -> five eight five is the code for it's the
290.58 -> main code for chronic kidney disease
292.979 -> okay so that's what they're saying that
295.02 -> if your patient has hypertension and
297.479 -> chronic kidney disease you're not going
299.25 -> to use a 401 code you're going to use a
300.719 -> 403 code and then you're going to get
303.509 -> the proper kidney disease code okay
305.61 -> unlike hypertension like I said before
307.409 -> with with heart disease where it has to
310.05 -> say the patient has heart disease beacon
314.4 -> and it's hypertensive heart disease you
316.919 -> know it has to say due to or all that
318.599 -> terminology to link it you don't have to
320.729 -> do that with CKD okay the appropriate
323.819 -> code 585 is for chronic kidney disease
326.129 -> and it is a C should be used secondary
330.06 -> okay so then when you get into the
331.919 -> primary in the secondary so let's say
333.93 -> you know it states a person who's
335.129 -> hypertensive chronic hidden disease the
337.02 -> 585 is gonna go second in the 403 will
339.15 -> go first and your guidelines in your
340.68 -> manual tell you this you don't have to
342.509 -> memorize it so you'll use the 403 to
346.409 -> identify that it's hypertensive the CKD
350.46 -> unspecified includes these things
352.71 -> chronic renal disease chronic renal
355.05 -> failure neither wise specified or
357.509 -> chronic renal insufficiency that all
359.789 -> means CKD okay so as you're going
362.909 -> through terminology and your anatomy
365.43 -> physiology courses and stuff like that
366.87 -> then you'll start seeing these other
368.849 -> terms and you'll know that's all chronic
371.37 -> kidney disease it's all lumped and then
373.139 -> under that umbrella
374.669 -> okay so acute and not otherwise
377.699 -> specified renal and sufficiency remains
380.58 -> classified as five 93.9 I just threw
382.56 -> that in there okay so if if a specific
386.75 -> CKD or in stage renal disease are both
390.839 -> documented you code only the end stage
393.69 -> renal disease that's bit but your
396.27 -> guidelines tell you that in the book so
397.74 -> you don't have to worry about memorizing
398.969 -> that so here's a little reminder
402.319 -> hypertension and CKD presumes that the
405.69 -> cause and effect relationship the HTN
407.759 -> and the CKD are going to be 403 point
410.339 -> nine zero and five eight five point nine
412.139 -> the 585 is kind of nice because it's
416.009 -> kidney disease and their stages for it
417.779 -> and stage one is like one stage three is
422.839 -> points
424.5 -> pennpoint 9 is unspecified so I think
427.319 -> you suck the last of the page I think
428.52 -> there's a poll for that where I gave an
431.55 -> example of a question oh there you go
434.55 -> so patient seen today for a review of
437.49 -> his hypertension oh that's not all the
440.759 -> questions but let's say it states
442.349 -> patient was seen today for a review of
444.21 -> his hypertension and is to continue his
447.84 -> medication for chronic kidney disease
449.61 -> stage 3 okay so if it's dead that so now
452.58 -> you know he's got chronic kidney disease
454.56 -> stage 3 which is five 85.3 you don't
457.349 -> have to guess I told you that's the
458.97 -> right answer but what are we gonna do
461.61 -> with the hypertension you've got four oh
463.68 -> four oh one point one which is benign
465.599 -> for one point nine which is essential
468.389 -> for oh three point nine zero which is I
473.419 -> have to see the hypertensive table to
475.68 -> see what it's actually called
476.97 -> but but for oh three point one zero is
480.389 -> benign hypertension associated with CKD
484.259 -> so for oh three point nine zero off the
486.659 -> top of my head is is hypertension as
491.61 -> relate with chronic kidney disease if we
495.15 -> had the hypertension table that we're
497.009 -> going to show you that the hypertension
499.83 -> table do you have it I did all you don't
502.11 -> maybe because the polls going on you
503.25 -> can't see ah yeah so if I give you that
505.71 -> information real quick which one do you
507.9 -> think that you're gonna pick you have to
509.789 -> have your terminology so patient was
511.56 -> seen today for a view of his
512.849 -> hypertension
513.74 -> he used to continue his meds for his
516.69 -> stage three chronic kidney disease and
519.539 -> closing the poll and sharing the poll
523.52 -> you're right for oh three point nine
525.839 -> zero because in the hypertension table
529.02 -> that is the unspecified whether benign
534.48 -> or malignant hypertension when a person
537.69 -> has chronic hidden disease whereas the
539.97 -> 403 point one zero was benign I believe
543.74 -> hypertension when the person has chronic
546.3 -> kidney disease and you're not going to
548.04 -> use the four oh one point one because
550.29 -> that's benign and four oh one point nine
552.449 -> is unspecified but when you use your cut
555.39 -> your hypertension table with
557.89 -> in the middle of the index under the HS
560.55 -> it's before your poison control table
563.14 -> it's going to tell you that if your
565.42 -> person has hypertension and then they it
568.959 -> says with chronic kidney disease you're
570.88 -> going to use these codes it works just
572.62 -> like that poison control table that we
575.529 -> used in previous webinars oh there you
579.94 -> go guys see real quick there now if you
582.19 -> look down you know this is all the
584.44 -> different hypertension codes look up at
586.24 -> the top you got malignant for a one
588.07 -> point zero four a one point one is
590.11 -> benign for a 1.9 is unspecified then you
593.589 -> go down and you find your person has
596.5 -> chronic kidney disease so you're gonna
598.92 -> scroll down till you fine oh right there
601.75 -> with okay chronic kidney disease you
604.36 -> know your person has stage three so well
607.839 -> one through four or unspecified so
611.23 -> there's your choices for oh three point
613 -> zero zero four OH three point one zero
614.589 -> and four oh three point nine zero Oh
617.29 -> doesn't Laureen snails look nice and
619.8 -> since benign was not mentioned you
623.529 -> cannot use the for Oh three point zero
626.949 -> zero and the for oh three point one zero
629.079 -> it is unspecified for oh three point
631.48 -> nine zero get more CPC exam tips coding
635.019 -> certification training and CEU credits
638.74 -> go to WWE certification or
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