By: Lorna Simons, CPC
Medco Consultants, Inc
The most delightful change to the ICD-10-CM guidelines (in my opinion) is that they made coding hypertension with heart disease easier. The new guideline presumes a causal relationship between the heart disease (I50.-; I51.4-I51.9) and hypertension (I10).
In previous years, the guidelines for hypertension indicated the use of combination codes for hypertension and heart disease when the causal relationship was stated or implied. Without the causal relationship the conditions would be coded separately. This meant that the documentation requirements for using the combination codes had to use specific language to indicate or imply the relationship. It also meant that billers would need to query the providers to ensure the proper codes were used.
The new guideline eases the documentation requirements for specific language. The combination codes should be used unless the providers documentation clearly indicates that they are separate.
For example, it would be appropriate to code I11.9 Hypertensive heart disease without heart failure and I51.5 Myocardial degeneration for a patient with documented hypertension and a history of Myocardial degeneration based on the new guideline. Previously, the patient note would have had to indicate the hypertension was due to myocardial degeneration.