Orthostatic hypotension 2016 2017 2018 2019 2020 2021 Billable/Specific Code I95.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2021 edition of ICD-10-CM I95.1 became effective on October 1, 2020.
The diagnosis of orthostatic hypotension is based entirely on a detailed history and physical exam. The physical exam must include orthostatic vital signs. All patients should be screened with orthostatic vitals, particularly in the case of the elderly. This is a simple and easy test that is often forgotten in the clinical setting.
Orthostatic hypotension. A significant drop in blood pressure after assuming a standing position. Orthostatic hypotension is a finding, and defined as a 20-mm hg decrease in systolic pressure or a 10-mm hg decrease in diastolic pressure 3 minutes after the person has risen from supine to standing.
Neurogenic orthostatic hypotension is characterized by autonomic instability secondary to neuropathic disease, neurodegenerative disease, or aging. Neuropathic diseases include diabetes, cholinergic receptor autoantibodies, and familial dysautonomia.
ICD-10 Code for Orthostatic hypotension- I95. 1- Codify by AAPC.
In ICD-10-AM/ACHI/ACS Tenth Edition, neurogenic orthostatic hypotension is classified to I95. 12 Neurogenic orthostatic hypotension. G90.
ICD-10 | Orthostatic hypotension (I95. 1)
ICD-10 code R55 for Syncope and collapse is a medical classification as listed by WHO under the range - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified .
Neurogenic orthostatic hypotension (nOH) is a subtype of orthostatic hypotension in which patients have impaired regulation of standing blood pressure due to autonomic dysfunction. Several primary and secondary causes of this disease exist. Patients may present with an array of symptoms making diagnosis difficult.
Condition: Orthostasis or orthostatic hypotension (OH) is a decrease in blood pressure that happens soon after standing or sitting up. When a person stands up, gravity causes blood to pool in the legs. This reduces blood pressure since less blood is circulating back to the heart to pump.
Overview. Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when standing after sitting or lying down. Orthostatic hypotension can cause dizziness or lightheadedness and possibly fainting.
Orthostatic hypertension refers to an increase in the blood pressure upon assuming an upright posture. This clinical condition has been understudied and is often underappreciated in clinical practice probably because of its unfamiliarity to many clinicians including subspecialists.
ICD-Code I10 is a billable ICD-10 code used for healthcare diagnosis reimbursement of Essential (Primary) Hypertension.
2 and R55, Syncope due to a third-degree atrioventricular block. When no related condition is defined and the symptom is the reason for the encounter, a code from Chapter 18 is assigned as the principal diagnosis even though other unrelated diagnoses may be listed.
R55 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM R55 became effective on October 1, 2021.
ICD-10 code E16. 2 for Hypoglycemia, unspecified is a medical classification as listed by WHO under the range - Endocrine, nutritional and metabolic diseases .
Orthostatic hypotension is defined as a sudden drop in blood pressure upon standing from a sitting or supine position. Clinically, this is diagnosed by a sustained reduction in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of 10 mmHg within three minutes of standing after being supine for five minutes or at a 60-degree angle on the tilt table. This sudden drop in blood pressure is usually secondary to failure of autonomic reflex, volume depletion, or adverse reaction to medication. Symptoms on presentation are commonly related to cerebral hypoperfusion, but patients can also be asymptomatic. There also is a high rate of morbidity and mortality related to this disease process due to frequent falls, which can lead to multiple hospital admissions. [1][2][3][4][5]
After five minutes of lying supine, the patient should be asked to stand quietly for two to five minutes, and vital signs should be taken again. If there is a 20 mmHg drop in systolic blood pressure or a 10 mmHg drop in diastolic blood pressure, one can make the diagnosis of orthostatic hypotension. [6][7][8][9]
Orthostatic hypotension can be caused by both neurogenic and non-neurogenic etiologies and can also be related to medication. Neurogenic orthostatic hypotension is characterized by autonomic instability secondary to neuropathic disease, neurodegenerative disease, or aging. Neuropathic diseases include diabetes, cholinergic receptor autoantibodies, and familial dysautonomia. Neurodegenerative diseases include Parkinson disease, multiple-system atrophy, and pure autonomic failure. Non-neurogenic orthostatic hypotension is most commonly due to volume depletion. One must also consider medication induced orthostatic hypotension particularly in the case of polypharmacy in the elderly.
Approximately 50% of patients with neurogenic orthostatic hypotension suffer from supine hypertension. This association is due to side effects from anti-hypertensive medications as well as the common autonomic dysfunction seen in these patients due to comorbid conditions, such as diabetes mellitus. There is currently no approved anti-hypertensive medication that selectively targets the supine position. This complicates treatment because supine hypertension in patients with autonomic failure can result in end organ damage. The treatment approach for these patients is currently being studied and might be an outlet for individualized based medicine in the future.
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.
The 2022 edition of ICD-10-CM I95.9 became effective on October 1, 2021.
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 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.
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 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.
In the absence of a universal definition, clinical guidelines describe hypotension as systolic blood pressure below 90-mmHg or mean arterial pressure (MAP) below 65-mmHg.1Hypotension is the main component of shock, a life-threatening condition of circulatory failure characterized by decreased oxygen delivery and/or increased oxygen consumption. Shock manifests with hypotension and may lead to tissue and cellular hypoxia.2