Hypertensive heart and kidney disease/HF sequencing

kerryseekircher

Good morning-
I am struggling with the sequencing when I have the following all documented:

* Pt admitted with acute on chronic diastolic CHF
* AKI on CKD-with component of cardiorenal syndrome.
* Pt also noted with history of hypertension.

Can I automatically go to 40491 as the pdx/ hypertensive heart and kidney disease based on above or does a better link need to be established/documented?
I have brought this to our coding supervisor who has advised I put in a ticket with 3m nosology, but thought I'd also ask here.

Also, does anyone have any good articles/resources on this topic?

Thanks,
Kerry

Kerry Seekircher, RN, BS, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

cmorell

A relationship between HTN and kidney disease is assumed.
A causal relationship between CAD and hypertension must be documented by the provider such as Hypertensive heart disease or HTN due to CAD.

ref: CC3Q1990 page 3, CC4Q2008 pages 236-241:

Heart conditions (425.8, 429.0-429.3, 429.8, 429.9) are assigned to a code from category 402 when a causal relationship is stated (due to hypertension) or implied (hypertensive).

Assign codes from category 403, Hypertensive chronic kidney disease, when conditions classified to categories 585-587 are present. Unlike hypertension with heart disease, ICD-9-CM presumes a cause-and-effect relationship and classifies chronic kidney disease (CKD) with hypertension as hypertensive chronic kidney disease.


A query such as this could be issued:

Hypertension is documented in the xx/xx/xx Progress note and CAD is documented in the xx/xx/xx Progress Note. Based on your clinical judgment please clarify if there is a relationship between the HTN and CAD? (E.g. Hypertensive heart disease CAD is due to Hypertension, CAD is not related to HTN, unable to clinically determine, other more appropriate diagnosis)
Clinical Indicators: Medical Record Location:
Systemic HTN H&P
list B/P readings Vital Signs dated xx/xx/xx
CAD, Cardiomyopathy H&P

The reason that you would want to do this is so that the combination code can be assigned as the PDx and the (e.g.) Ac Sys CHF can be coded as a MCC.


Charlie Morell

jolene.file

Agree with Charlie. He explained the linkage issue exactly & provided references.

Jolene File,RHIT,CCS,CPC-H,CCDS
Documentation Improvement Specialist-Coder
Hays Medical Center
jolene.file@haysmed.com

IMPORTANT: This communication contains information from Hays Medical Center which may be confidential and privileged. If it appears that the communication was addressed or sent to you in error, you may not use or copy this communication or any information contained therein, and you may not disclose this communication or the information contained therein to anyone else. In such circumstances, please notify me immediately by reply email or by telephone. Thank you.

angelamckee@uh.org

You can automatically go to 404 when you have documentation of "cardiorenal
syndrome".

Per Coding Clinic July- August 1984 Page 12 to 17 Hypertensive disease - guidelines:

Hypertensive heart and renal disease (404.0-404.9) is also referred to as cardiorenal disease or hypertensive heart
disease with nephrosclerosis. The diagnosis of hypertensive cardiovascular and renal disease or hypertensive
cardiovascular renal disease merits referencing the discharge summary or medical record for any specific references to
presence of coronary arteriosclerosis, angina pectoris, or chronic coronary insufficiency that would require additional
coding. As previously mentioned, cardiovascular hypertension may imply the presence of a coronary artery disease.

Thank you,

Angie McKee, RHIT, CCDS, CCS, CCS-P
AHIMA Approved ICD 10 Trainer
Clinical Documentation Specialist
Performance Improvement
University Hospital
1350 Walton Way,
Augusta, Ga 30901

don.cdi.rn@gmail.com

Agreed.

However, the term is also used clinically to describe a different
situation than what the code captures. This was discussed in the Feb
Quarterly Conference call. I thought there was a handout, but don't see
a link. The call is available recorded on ACDIS.

As I understand, the physician may be actually referring to the
circumstance where the decompensated HF, fluid changes, diuresis, etc.
results in an AKI picture. This is quite different from the intent of
the code where there is chronic disease and impact from HTN on both
renal and heart -- specifically, HTN is the/one of the underlying causes
of the chronic HF.

We will query in this circumstance to clarify with the physician if
they intended by the term cardiorenal to describe chronic htn heart dz.
Don't have a sample available at this time.

Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation Advisor Program
Vidant Health, Greenville NC
DButler@vidanthealth.com ( mailto:mDButler@vidanthealth.com )

kerryseekircher

Thank you all for your responses-they have been extremely helpful.
Kerry