Coding for Hypertension: Painting a Picture of the Severity of Illness

 

As risk-adjustment scoring increases, the pressure is on to code hypertension correctly. Here's an overview using common patient scenarios.

Fam Pract Manag. 2020 Mar-Apr;27(2):23-30.

Author disclosures: no relevant financial affiliations disclosed.

Related article from American Family Physician: “Managing Hypertension Using Combination Therapy.”

When a patient presents with elevated blood pressure, your documentation and coding should paint a picture of the severity of the patient presentation. Is the patient generally healthy but presenting with a single episode of elevated blood pressure, is the patient chronically ill with hypertension that has affected other organ systems, or is the patient's condition somewhere in between? With today's focus on population health management and documentation to support correct assignment of hierarchical condition categories (HCCs) for risk-adjustment scoring, it is more important than ever that family physicians understand current codes and guidelines. (See “Hypertension in risk adjustment.”)

The patient scenarios presented in this article are intended to illustrate correct coding for elevated blood pressure and hypertensive conditions commonly seen in primary care. They are not intended to reflect advice on the practice of medicine or to indicate that coding would be the same for all patients with similar presentations. Code selection should be based on documentation specific to each unique patient presentation, including clinical findings and documented medical decision-making (e.g., management options affected by comorbidity).

Although documentation and coding for hypertension can be confusing, it essentially comes down to four questions:

  1. Is hypertension the diagnosis, or is elevated blood pressure the appropriate diagnosis?

  2. If hypertension is the diagnosis, is it primary or secondary?

  3. Is there hypertensive urgency or emergency?

  4. Does the patient also have heart or kidney disease?

With that framework in mind, let's take a look at some common scenarios.

KEY POINTS

  • Proper ICD-10 coding of hypertension will help demonstrate the severity of the patient's illness, which can affect payment under value-based payment models.

  • The first distinction you must make is whether the appropriate diagnosis is hypertension or simply elevated blood pressure.

  • The patient scenarios in this article demonstrate proper diagnosis and procedure coding for suspected hypertension, primary or secondary hypertension, hypertensive crisis, and hypertension present with heart or kidney disease.

ELEVATED BLOOD PRESSURE WITHOUT DIAGNOSIS OF HYPERTENSION

To record an episode of elevated blood pressure in a patient who has no formal diagnosis of hypertension or an isolated incidental finding, you should report ICD-10 code R03.0, “Elevated blood-pressure reading, without diagnosis of hypertension.” This code applies to borderline, transient, or white-coat hype

ABOUT THE AUTHOR

Cindy Hughes is an independent consulting editor based in El Dorado, Kan., and a contributing editor to FPM.

Author disclosures: no relevant financial affiliations disclosed.

 
 
 

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