ICD-10-CM Hypertension, Heart Disease and CKD
Dr Santosh Guptha MEDESUN
CKD Stages •
If both a stage of CKD and ESRD are documented, assign code N18.6 only Stage-1 N18.1
Stage-2 N18.2-MILD
Stage-3 N18.3Moderate
CKD Stages
Stage-4 N18.4-Severe
Stage-5 N18.5
ESRD N18.6
CHRONIC KIDNEY DISEASE
Use the code for Stage 5 when the GFR hits the 15 mL/min threshold for kidney failure, but dialysis has not been started. Once it has, use the code for ESRD. GFR
Stages of Chronic Kidney Disease
% of Kidney Function
90 or Higher
Stage 1
Kidney damage with normal kidney function
90-100%
89 to 60
Stage 2
Kidney damage with mild loss of kidney function
89-60%
59 to 30
Stage 3a
44 to 30
Stage 3b
Moderate to a severe loss of kidney function
44-30%
29 to 15
Stage 4
Servers loss of kidney function
29-15%
Less than 15
Stage 5
Kidney Failure
Mild to moderate loss of kidney function
59-45%
Less than 15%
Hypertension, Heart Disease, CKD
Hypertensive Diseases
HTN
Hypertensive Heart Disease
Hypertensive CKD
Hypertensive Heart and CKD
I10
I11-
I12-
I13-
CRF/CKD/CRI + hypertension
I12.9 + N18.9
CKD stage 1 + hypertension
I12.9 + N18.1
CKD stage 2 + hypertension
I12.9 + N18.2
CKD stage 3 + hypertension
I12.9 + N18.30-N18.32
CKD stage 4 + hypertension
I12.9 + N18.4
CKD stage 5 + hypertension
I12.0 + N18.5
CKD stage 5 + hypertension + chronic dialysis
I12.0 + N18.6 + Z99.2
ESRD + hypertension + chronic dialysis
I12.0 + N18.6 + Z99.2
CKD NOS + hypertension + chronic dialysais
I12.9 + N18.6 + Z99.2
Hypertensive heart disease
Category I11 is subdivided to indicate whether heart failure is present: I11.0 I11.9
Hypertensive heart disease with heart failure Hypertensive heart disease without heart failure
Example: A patient is discharged with a diagnosis of exacerbated chronic diastolic congestive heart failure and a secondary diagnosis of hypertension. Codes reported: I11.0 Hypertensive heart disease with heart failure I50.32 Chronic diastolic (congestive) heart failure ICD-10-CM assumes a cause-and-effect relationship between CKD and HTN, as well as CKD and diabetes. CKD is most likely related to both the HTN and the diabetes when all three conditions are present. High blood pressure and high blood sugar in the blood vessels can lead to the deterioration of the vessels, which can then cause damage to the kidneys.
Coding Hypertensive Chronic Kidney Disease When the diagnostic statement includes both HTN and a condition classifiable to category N18 Chronic kidney disease, ICD-10CM presumes a causal relationship and categorizes the condition as hypertensive chronic kidney disease (CKD). Use a code from category I12 to describe these two related disorders, even in the absence of documentation linking them. A fourth character is used with category I12 to indicate the stage of CKD. Sequence first the I12 code for the combined diagnosis of HTN with CKD: I12.0
Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease These two codes also require that you report a secondary code from category N18 to identify the stage of kidney disease, with documentation typically referencing the most recent estimated glomerular filtration rate (eGFR) — the best test to measure the level of kidney function and determine the stage of renal disease.
In cases where the documentation clearly states the CKD is not related to the HTN, the conditions should be coded separately. The guidelines further specify that if a patient has hypertensive chronic kidney disease and acute renal failure, an additional code for acute renal failure is required. Example: A provider documents HTN and stage IIIb kidney disease based on the patient’s most recent comprehensive metabolic profile, which showed elevated blood urea nitrogen (BUN) and creatinine and an eGFR at 40. Repeat testing yields a similar result. Codes reported: I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease N18.32 Chronic kidney disease, stage 3b
Coding Hypertensive Heart and CKD Coding Hypertensive Heart and CKD If a patient has all three conditions documented — HTN, heart disease, and CKD — look to combination category I13 for code assignment. Codes for the three-disease combination are numerically arranged by the degree of CKD and then further differentiated by the presence or absence of heart failure. Example: The patient in the example above presents with new-onset moderate pedal edema, and, upon examination, the provider detects mild crackles bilaterally at the lung bases. An echocardiogram is ordered, which shows mild systolic heart failure. Her eGFR has remained stable. The provider documents all three conditions. Codes reported: I13.0 Hypertensive heart and chronic kidney disease with heart failure and with stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease I50.21 Acute systolic (congestive) heart failure N18.32 Chronic kidney disease, stage 3b
For patients with both acute renal failure and chronic kidney disease, the acute renal failure should also be coded. Sequence according to the circumstances of the admission/encounter
Coding for Secondary HTN Some patients have high blood pressure caused by another medical condition such as those that affect the kidneys, arteries, heart, or endocrine system. In these cases, the ICD-10-CM HTN codes discussed above cannot be used. Instead, turn to the codes in category I15 Secondary hypertension. The five secondary hypertension codes require that you also code the underlying condition. The first-listed code is determined based on the reason for the patient encounter. Example: A patient is being seen for blood pressure management. The provider documents acromegaly — a hormonal disorder that develops when the pituitary gland produces too much growth hormone during adulthood — with secondary hypertension. Codes reported: I15.2
Hypertension secondary to endocrine disorders
E22.0
Acromegaly and pituitary gigantism
Examples 1
2
3
5
HTN coding examples patient presents with transient HTN occurring during the postoperative period. ICD-10-CM: Transient HTN is considered elevated blood pressure (R03.0) Rationale: This is assigned because the physician did not document whether the transient HTN was related to, or a complication of the procedure.
6
Patient presents with congestive heart failure (CHF) due to hypertensive heart and renal disease with CKD, unspecified? ICD-10-CM: hypertensive heart and CKD with heart failure and CKD unspecified (I13.0), CHF unspecified. (I50.9) and CKD unspecified (N18.9)
Patient presents with CHF due to HTN.
6
7
ICD-10-CM: hypertensive heart disease with heart failure ( I11.0) and CHF unspecified (I50.9)
A patient is diagnosed with CHF due to diastolic dysfunction with HTN. ICD-10-CM: hypertensive heart disease, unspecified, with heart failure (I11.0) and unspecified diastolic (congestive) heart failure (I50.30)
8
A patient presents to the hospital for treatment of CHF. The patient also has hypertensive nephropathy with ESRD, on dialysis. ICD-10-CM: hypertensive Heart and CKD with heart failure and CKD unspecified (I13.0), CHF unspecified (I50.9), ESRD (N18.6) and dialysis status (Z99.2) Rationale: A code from category I13 is used because there is an assumed relationship between CHF and HTN unless documented states otherwise.