The Complete
Diagnosis Coding Book
by
Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA
Chapter 4
Coding Circulatory Conditions
McGraw Hill/Irwin
Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved
4-2
Learning Outcomes
· Interpret the difference between elevated
blood pressure and hypertension.
· Correctly evaluate the hypertension table
in the alphabetic index.
· Determine the level of hypertension to
be coded.
4-3
Learning Outcomes
· Identify manifestations that must be coded
separately.
· Distinguish coding guidelines for
cardiovascular accidents.
· Apply the guidelines correctly to code a
stroke.
4-4
Introduction
· Circulatory conditions, such as
hypertension, are systemic. They affect
the entire body.
· Circulatory conditions are almost always
coded.
4-5
Hypotension
Patient’s blood pressure is lower than
normal:
· Can cause a lack of oxygen
· Common symptoms: lightheadedness and
dizziness
4-6
Hypertension
Patient’s blood pressure is consistently too
high:
· Can cause damage to organs, especially
heart and kidneys
· Must be specifically diagnosed by the
physician
4-7
Elevated Blood Pressure
A temporary or occasional increase in the
patient’s blood pressure:
· May be caused by nervousness, caffeine,
or stress
4-8
Hypertension
· Hypertension may be uncontrolled or
controlled.
· Controlled hypertension is successfully
being treated.
· Either diagnosis does not affect the code
assignment.
4-9
Hypertension
• Malignant: Very unusual; extremely high blood
pressure accompanied by papilledema, organ
damage, and so on
• Benign: More common; typically controlled
with diet and medication
• Unspecified: Not stated in documentation
whether the condition is malignant or benign
4 - 10
Essential Hypertension
· This is the most common type of
hypertension.
· Use code 401 with the appropriate
fourth digit.
· ALL hypertension codes require at
least four digits.
4 - 11
Hypertension + Heart
· Code 402.x:
· Heart condition DUE TO
hypertension
· HYPERTENSIVE heart condition
· One code only
4 - 12
Hypertension + Heart
· Code 401.x + heart code:
· Heart condition WITH hypertension
· Code heart code + 402.xx:
· Heart failure DUE TO hypertension
4 - 13
Hypertension + Kidney
· Code 403.xx + second code:
· Fifth digit identifies the stage of chronic
kidney disease.
· Second code reports specific stage of
kidney disease.
Hypertension + Heart +
Kidney
Code 404.xx:
· + Code for heart failure
· + Code for stage of kidney disease
4 - 14
4 - 15
Secondary Hypertension
+ Code 405.xx:
· First, list the underlying condition,
that is, the disease that caused the
patient to have hypertension.
· Second, list code 405.xx.
4 - 16
Hypertension + Pregnancy
Gestational hypertension 642.3x:
· Diagnosis of hypertension existed
prior to the beginning of the
pregnancy; code 401.x if no impact
on mother’s condition.
4 - 17
Hypertensive Retinopathy
Two codes will be required:
· 362.11 Hypertensive retinopathy
· + Hypertension code
Hypertensive
Cerebrovascular Disease
Two codes are required:
· 430–438 Cerebrovascular disease
· + Hypertension code
4 - 18
4 - 19
Cerebrovascular Issues
· Cerebrovascular accident (CVA)
· Stroke
· Cerebral infarction
4 - 20
Chapter Summary
· Circulatory conditions such as
hypertension can be very complex due
to their effect on the entire body.
· Ensure that the documentation is
complete.