We calculated the proportion and counts of cases with at least one hypotension
A blood pressure reading below the specified limit (90/60 mmHg).
Short description: Shock w/o trauma NEC. ICD-9-CM 785.59 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 785.59 should only be used for claims with a date of service on or before September 30, 2015.
Hypotension, unspecified. ICD-9-CM 458.9 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 458.9 should only be used for claims with a date of service on or before September 30, 2015.
Apr 19, 2021 · We calculated the proportion and counts of cases with at least one hypotension code (ICD-9: 458.29, 458.8, 458.9; ICD-10: I95.0, I95.81, …
2012 ICD-9-CM Diagnosis Code 958.4 Traumatic shock ICD-9-CM 958.4 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 958.4 should only be used for claims with a date of service on or before September 30, 2015.
This analysis revealed an overall low utilization of hypotension codes among known hypotensive cases. Only 13.3% of all shock cases included a hypotension code. The lack of a single, standardized definition of hypotension may partly explain the underutilization of these codes.15Clear guidance and thresholds regarding the diagnosis of hypotension might increase the use of appropriate diagnosis codes.
Despite being the most prevalent shock type, the septic shock had the lowest hypotension code rate. The difference between septic shock and other shock types can be partially explained by the Surviving Sepsis guidelines, which provides a detailed evaluation of sepsis, including a MAP <65-mmHg threshold for diagnosing septic shock.16Physicians may be documenting hypotension relatively less in septic shock patients due to the MAP criterion in the diagnosis of septic shock. In contrast, the hypotensive patients with other shock types, which lack a similar guideline, may be more likely to receive a separate hypotension code. However, the differences among shock diagnosis guidelines (ie the presence of MAP criteria) do not explain the overall low utilization for hypotension across shock types.
Accurate coding of hypotension may lead to higher quality retrospective research and improved accuracy for a national burden estimate, which could increase funding for research, education, and treatment for hypotensive patients.13De spite its widely-known shortcomings (ie delay in availability, limited clinical information, sensitivity), claims data is increasingly being used in health services research as an efficient and relatively low-cost data source.10,19–21Moreover, claims databases provide a combination of clinical and reimbursement-related information for almost all health encounters, which is especially beneficial when high-volume and long-term follow-up is important to the research.19Information from the claims data may also be used to complement other data. The Food and Drug Administration previously established national strategies by combining information from registries, EHR, and claims databases.19Furthermore, Hlatky et al and Brennan et al suggested that claims data can be used to evaluate outcomes of participants with reasonable accuracy in later phases of large pragmatic clinical trials and medical device surveillance systems, respectively.19,20
Exposure to hypotension is harmful to patients and may lead to significant mortality and morbidity.3,4Accurate inclusion of hypotension in medical records may have positive downstream impacts on patient care by supporting quality monitoring/improvement initiatives as well as informing program development and patient identification for payer-based population health initiatives (ie care management).18The importance of record-keeping is likely to increase as CMS is currently testing the submission of quality measure data through electronic health records (EHR).11A quality measure evaluating hypotension was recently adopted by CMS, which will impact payments to providers in the Merit-based Incentive Payment System.12As payers increase data requirements from the providers, clear documentation of major and comorbid conditions may have a more significant impact in the future pay-for-performance programs.7Clearly defined hypotension codes could reduce the burden of reporting.
A total of 2,200,275 shock patients were analyzed, 13.3% (n=292,192) of which received a hypotension code. Hypovolemic shock cases were the most likely to receive a hypotension code (18.02%, n=46,544), while septic shock cases had the lowest rate (11.48%, n=158,348). The proportion of patients with hypotension codes for other cohorts were 18.0% (n=46,544) for hypovolemic shock and 16.9% (n=32,024) for other/unspecified shock. The presence of hypotension codes decreased by 0.9% between 2011 and 2014, but significantly increased from 10.6% in 2014 to 17.9% in 2017 (p <0.0001, Z=−105.05).
Accurate coding is likely to improve health services research and quality initiatives, which may consequently improve patient outcomes. Further research is required to establish the causal relationship between the utilization of hypotension codes and improvements in patient outcomes.
Hypotension code utilization for shock patients decreased initially from 11.5% (2011) to 10.6% (2014), however, it increased in each subsequent year to 17.9% by 2017 (p <0.0001, Z= −105.0520; years 2011–2017). The surge in hypotension code utilization was significant for all shock types based on a Cochran-Armitage trend test (Table 3). The presence of shock codes trended upwards, with an 18.9% overall increase in the number of reported cases between 2011 (n=286,354) and 2017 (n=340,544).
The 2022 edition of ICD-10-CM I95.9 became effective on October 1, 2021.
Transient hypotension. Clinical Information. A disorder characterized by a blood pressure that is below the normal expected for an individual in a given environment. Abnormally low blood pressure that can result in inadequate blood flow to the brain and other vital organs.
cardiogenic shock, caused by the inability of the heart to pump blood effectively. neurogenic shock, caused by extreme emotional upset due to personal tragedy or disaster. symptoms of shock include cold and sweaty skin, weak but rapid pulse, irregular breathing, dry mouth, dilated pupils and reduced urine flow.
Shock often accompanies injury.specific types of shock include. hypovolemic shock, caused by internal or external bleeding. septic shock, caused by infections in the bloodstream. anaphylactic shock, caused by a severe allergic reaction. cardiogenic shock, caused by the inability of the heart to pump blood effectively.
Causes of shock include internal or external bleeding, dehydration, burns, or severe vomiting and/or diarrhea. All of these involve the loss of large amounts of body fluids.
The 2022 edition of ICD-10-CM R57.9 became effective on October 1, 2021.