Alright, hypertension and chronic kidney disease.
Thatís Aliciaís.
I guess Iíll bring that answer sheet up.
Alicia: Yeah.
And you know what?
You guys, I just took a class on this so itís very exciting.
I just feel like my little spongy brain has absorbed all kinds of information and it was
a lot of fun.
Iíve struggled with this too.
So hypertension, abbreviated HTN if you guys didnít know that you know, what is hypertensive
disease?
And itís so broad that you know, you canít really define it per se.
But the main thing about hypertension is you want to know is it essential or primary hypertension?
OkayÖ and itís 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 thatÖ 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 codeÖ I always laugh because the first code that most new coders
learn is 401.9 because you see it a lot especially if youíre coding for Medicare patients.
Everybody seems to have hypertension.
So letís see, the physician must document if the patientís hypertension is benign or
malignant in order to get your 4th digit.
Okay so if it doesnít say whether itís 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.
Okay so what would you code if you have a diagnosis of elevated blood pressure without
a diagnosis of hypertension?
Thatís something else.
Thatís actually 796.2 which reads elevated blood pressure, reading without diagnosis
of hypertension.
Okay, what if you have an encounter of elevated blood pressure and then the patientís taking
Benicar and they refill their Benicar for 3 months you know, what would you use?
Youíre actually going to use the 401.9 because Benicar is used to control hypertension.
So that way, it says elevated blood pressure.
Youíre not going to use that 796.2.
Theyíre actually treating them for hypertension so you would use the 401.9.
Okay, we need to make sure that the patient has hypertension from the documentation in
order to code the hypertension though.
So as we scroll down, these are the key ones that you need to know in order to code 401.1.
It has to say itís benign hypertension.
In order for it to be 401.0, it has to be malignant in the documentation.
And if it doesnít state whether itís benign or malignant then youíre going to default
to 401.9.
And for you new coders out there, theyíre just starting to go through the codes.
If something ends in a 9 in ICD 9, it usually means itís unspecified.
Okay, thatís yourÖ youíll notice that as you go along.
Now for your chronic kidney disease, the CKD.
So some diagnoses have to be supported with link you know, they have to link in likeÖ
you have hypertension and CAD then you know, they have toÖ the doctor has to specifically
say that theyíre linked for you to be able to code certain codes.
But with hypertension and CKD, you donít have to have support.
So in other words, theyíre saying if the patient has a chronic kidney disease and they
have hypertension, youíre going to go to your hypertensive table and use those codes.
So as we scroll down to CKD for our next page, assign codes from category 4 or 3, hypertensive
chronic kidney disease when conditions classified to category 585 or 587 or present with hypertension.
Now, that may sound kind of scary to new coders but 585 is the code forÖ is the main code
for chronic kidney disease.
Okay so thatís what theyíre saying that if your patient has hypertension and chronic
kidney disease, youíre not going to use a 401 code.
Youíre going to use a 403 code and then youíre going to get the proper kidney disease code.
Okay, unlike hypertension, like I said before with heart disease where it has to say the
patient has heart disease and itís hypertensive heart disease you know, it has to say due
to or all that terminology to link it, you donít have to do that with CKD.
Okay, the appropriate code, 585 is for chronic kidney disease and it is aÖ it should be
your secondary.
So when you get into the primary and the secondaryÖ so letís say you know, it states person has
hypertensive chronic kidney disease.
The 585 is going to go second and the 403 will go first and your guidelines in your
manual tell you this.
You donít have to memorize it.
So youíll use the 403 to identify that itís hypertensive.
The CKD unspecified includes these things: chronic renal disease, chronic renal failure
ñ not otherwise specified or chronic renal insufficiency.
That all means CKD.
Okay so as youíre going through terminology and your anatomy and physiology courses and
stuff like that then youíll start seeing these other terms and youíll know thatís
all chronic kidney disease.
Itís all lumped under that umbrella.
Okay so acute and not otherwise specified renal insufficiency remains classified as
593.9, just throwing that in there.
Okay so if a specific CKD or end stage renal disease are both documented, you code only
the end stage renal disease.
ThatísÖ but your guidelines tell you that in the book so you donít have to worry about
memorizing that.
So hereís your little reminder: hypertension in CKD presumes that the cause and effect
relationship, the HTN and the CKD are going to be 403.90 and 585.9.
The 585 is kind of nice because itís kidney disease and there are stages for it.
And stage 1 is like 1 or stage 3 is .3, .9 is unspecified.
So I think is that the last of the page?
I think thereís a poll for that where I gave an example of a question.
There you go.
So patient seen today for review of his hypertension.
Oh, thatís not all the question.
But letís say its date.
Patient was seen today for review of his hypertension and is to continue his medication for chronic
kidney disease stage 3.
Okay so it said that so now you know.
Heís got chronic kidney disease stage 3 which is 585.3.
You donít have to guess, I told you thatís the right answer.
But what are we going to do with the hypertension?
Youíve got 401.1 which is benign, 401.9 which is essential, 403.90 which isÖ I have to
see the hypertensive table to see what itís actually called.
But 403.10 is benign hypertension associated with CKD.
So 403.90 off the top of my head is hypertension with chronic kidney disease.
If we had the hypertension table, weíll show you that.
Laureen: Do you see it?
Alicia: The hypertension table?
Do you have it?
Laureen: I did.
Oh you donít maybe because the pollís going on.
You canít see it.
Alicia: Oh yeah.
So if I give you that information, real quick, which one do you think that youíre going
to pick?
You have to have your terminology.
So patient was seen today for review of his hypertension.
He is to continue his meds for his stage 3 chronic kidney disease.
Boyd: This oneís taking a little time, huh?
Alicia: Yeah, just guess.
Boyd: 50% voted now.
Alicia: Thatís probably good.
Boyd: 62, okay great.
Iím going to go and close it in 3, 2, 1Ö 70% voted.
Great, guys.
Thank you.
And closing the poll and showing the poll.
Alicia: Youíre right.
403.90 because in the hypertension table, that is the unspecified, whether benign or
malignant hypertension when a person has chronic kidney disease.
Whereas the 403.10 was benign, I believe, hypertension when the person has chronic kidney
disease.
And youíre not going to use the 401.1 because thatís benign and 401.9 is unspecified.
But when you use your hypertension table which is in the middle of the index under the Hís,
itís before your poison control table, itís going to tell you that if your person has
hypertension and then theyÖ it says ìwith chronic kidney diseaseî youíre going to
use these codes.
It works just like that poison control table that we used in previous webinars.
Laureen: Alright, great.
But did you need to show anything in the hypertension table?
Alicia: There you go, guys.
See real quick there?
Now if you look down, this is all the different hypertension codes.
Look up at the top.
You got malignant, 401.0. 401.1 is benign. 401.9 is unspecified.
Then you go down and you find your person has chronic kidney disease.
So youíre going to scroll down until you findÖ oh right there, with chronic kidney
disease.
You know your person has stage 3 so 1 through 4 or unspecified.
So thereís your choices, 403.00, 403.10 and 403.90.
Oh, doesnít Laureenís nails look nice.
And since benign was not mentioned, you cannot use the 403.00 and the 403.10.
It is unspecified, 403.90.