Essential (primary) hypertension: I10 In ICD-9, essential hypertension was coded using 401.0 (malignant), 401.1 (benign), or 401.9 (unspecified). ICD-10 uses only a single code for individuals who meet criteria for hypertension and do not have comorbid heart or kidney disease. That code is I10, Essential (primary) hypertension.
As noted earlier, each category is currently divided into malignant, benign, and unspecified essential hypertension with or without heart failure. In ICD-10, this is narrowed to only two base codes: • I11.0, Hypertensive heart disease with heart failure, • I11.9, Hypertensive heart disease without heart failure.
Codes in this new category differentiate hypertensive urgency (I16.0), hypertensive emergency (I16.1), and hypertensive crisis, unspecified (I16.9). The American Academy of Pediatrics requested detailed codes to track patients who present with clinically significant hypertension that requires immediate treatment.
Similarly, a single mildly elevated blood pressure reading should be coded with the R03.0 until the formal diagnosis is established. Although various sources define hypertension slightly differently, the provider should document elevated systolic pressure above 140 or diastolic pressure above 90 with at least two readings on separate office visits.
Follow your ICD-10 guidelines. The alphabetic index directs you to code N25.81 for 'secondary hyperparathryoidism' - renal is a parenthetic term and so is not required to be documented. You would only code E21.1 if documentation indicates that the hyperparathryoidism is non-renal in origin.
Another way to look at it is that 'with' and 'in', in ICD-10, mean simple that the two conditions both are present in the documentation. 'Due to' does not allow this - this term must be documented.
If the patient only had a diagnosis of DM2 without complications, then you would be looking at E11.9 of course.#N#Now, if the patient has a diagnosis of DM2 and CKD, then at that point the code E11.22 covers the diabetes WITH complication being CKD, then the code asks for an additional code to specify the stage of the CKD being the N18.3.#N#Hope this helps.
The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated. For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related.
so if a patient has a diagnosis of Chronic kidney disease and diabetes, and there is no linkage of both conditions, in this case you would be able to code with the E11.22 combining CKD and diabetes and then also adding the N18.9. We are doing this because your index provides a specific "with" entry for chronic kidney disease under diabetes melliltus.
If the patient has cardiovascular disease and hypertension it is presumed they are linked. In those cases there is a code that links them rather than using two separate codes. There is no code that links diabetes and hypertension. I15.2 is secondary hypertension. Those types of illnesses are aldosteronism, pheochromocytoma, Cushing's syndrome, hyperparathyroidism and hypo- and hyperthyroidism.
There is no presumed causality between hypertension and DM. If the provider has not documented that this is secondary hypertension, then this should be coded as I10, E11.9.
The ICD-10-CM Official Guidelines for Coding and Reporting state, “Assign a code from category I16, Hypertensive crisis, for documented hypertensive urgency, hypertensive emergency or unspecified hypertensive crisis. Code also any identified hypertensive disease ( I10 - I15 ). The sequencing is based on the reason for the encounter.”
A hypertensive crisis (urgency or emergency) occurs when blood pressure elevates rapidly and severely enough to potentially cause organ damage. Patients may present with symptoms of acute headache, shortness of breath, epistaxis, or marked anxiety. Immediate evaluation is needed to assess organ function, and determine appropriate treatment.
A hypertensive emergency occurs when blood pressure is severely elevated and results in organ damage. The condition can also occur at lower levels in patients whose blood pressure had not previously been high. Serious consequences of uncontrolled hypertension include stroke, loss of consciousness, memory loss, acute myocardial infarction, angina, aortic dissection, damage to the eyes and kidneys, and pulmonary edema. During pregnancy, eclampsia can also develop along with a hypertensive emergency.
Assign code I61.0, Nontraumatic intracerebral hemorrhage in hemisphere, subcortical, as the principal diagnosis for the right basal ganglia hemorrhage. Code I16.1, Hypertensive emergency, and code I10, Essential (primary) hypertension, are assigned as additional diagnoses. For the procedure assign the following ICD-10-PCS code:
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