HTN, ckd, chf
According to the 2017 guidelines - linkage between HTN and "heart involvement" and kidney involvement ( already assumed) will not require a link.http: //www.cdc.gov/nchs/data/icd/10cmguidelines_2017_final.pdf
So if I understand it correctly-every patient with HTN, CKD and acute CHF will automatically be MCC'd I13.0 or I132...
This is odd to me because to query for the term hypertensive heart disease certain clinical evidence, historically needed to be present, like LVH. Docs don't always agree now that the hypertension causes the heart disease.
Chapter 9 in the 2017 coding guideline... states an assumption of htn, heart disease and ckd even if the term with is not stated...
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. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states 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. ((( The second statement should probably read for htn and OTHER conditions ... provider must be link)))) 1) Hypertension with Heart Disease Hypertension with heart conditions classified to I50.- or I51.4-I51.9, are assigned to a code from category I11, Hypertensive heart disease. Use an additional code from category I50, Heart failure, to identify the type of heart failure in those patients with heart failure. This like the preserved HFp EF coding to diastolic heart failure, is odd. I have seen "Acute HFpEF" written and the echo states " normal diastolic dysfunction- but we are coding acute diastolic CHF. --- all this being said... would this ever come in to play if CHF weren't ACUTE and POA? because it would just be a secondary condition ... right? do you think it's because doctors lack of linking of htn to relationship to heart disease is not capturing a relationship... CMS thinks should be established? even if the docs would not feel that they would make the assumption, yet CMS will?
Tagged:
Comments
Hypertension with Heart Disease
Hypertension with heart conditions classified to I50.- or I51.4-I51.9, are assigned to a code from category I11, Hypertensive heart disease. Use an additional code from category I50, Heart failure, to identify the type of heart failure in those patients with heart failure.
ICD-10-CM Official Guidelines for Coding and Reporting FY 2017 Page 43 of 114
The same heart conditions (I50.-, I51.4-I51.9) with hypertension are coded separately if the provider has specifically documented a different cause. Sequence according to the circumstances of the admission/encounter
Hypertension, hypertensive (accelerated) (benign) (essential) (idiopathic) (malignant) (systemic) I10 - with
- - heart involvement (conditions in I51.4- I51.9 due to hypertension) -see Hypertension, heart
- - kidney involvement -see Hypertension, kidney
- heart (disease) (conditions in I51.4-I51.9 due to hypertension) I11.9
- - with
- - - heart failure (congestive) I11.0
- - - kidney disease (chronic) -see Hypertension, cardiorenal- - with
- - - heart failure (congestive) I11.0
- - - kidney disease (chronic) -see Hypertension, cardiorenal
This is a problem for me as well. I have a patient with a history of hypertension. Came in with acute systolic heart failure and has CKD. The patient is hypertensive. Do I query for hypertension as an active problem?? Then my acute systolic CHF can be my MCC. Not certain that seems correct?
My understanding is that if the patient comes in with acute chf or acute kidney injury when they have ESRD... ( htn hx) an I13___ code will be automatic and the acute specified chf or the ESRD will be the MCC.
For me the potential query opportunity would be, any time ACUTE __CHF, is present, look for the other two conditions. if they are there you should be in I13__ if not... is there evidence of those chronic conditions that are not diagnosed or not in the current record?
Often CKD 2 is not diagnosed, GFR 60-90. That GFR value should be not taken exclusively in an exacerbated state, but if evidence suggest that the GFR lives below 90 ( not all hospitals lab values specify values greater than 60- but if your's does, you can look at that), then it is reasonable to ask and get that chronic relevant condition in the chart. ... Same with HTN, I have had to look hard sometimes, and really it has just fallen out of their history but they are on lots of cardiac medications, have chf, and ckd... the likelihood they DON'T have HTN is pretty low.
I think it's a new area we will start hearing more and more opinions on. I'd definitely try to discuss it with your cdi and coding teams, if you have a confident, collaborative, supportive team you may find this a great query opportunity. As always if a consultant hasn't spelled it out and sold it to your facility, some people don't have confidence in their own clinical judgement, but it will evolve I'm sure.
Thanks annnd2009 for the input. I wasn't certain how to handle the hypertension. I am looking at this as opportunity as well.
I hope they publish their advice on this. I was going to submit the same question but searched this forum and saw that you had submitted already.
Cathy Seluke
Many are questioning the intent of these guidelines given they represent quite a departure from previous advice and published Guidelines. However, for now at least, the relationship is 'assumed'.
Paul Evans
Cathy
Hi, Cathy - I am 'lost' in the thread, and don't see it.
Do you wan to call me? 415.412.9421
Paul
Although controversial, the Guidelines now assume a certain linkage between HTN, CKD AND CHF. Further, if the MD also links the hypertension to the CHF, the combination codes are used. Have you searched this site for articles and guidance for this topic as I recall various members have offered very helpful advice w/ citations.
Paul Evans, RHIA, CCDS