Coding Tip: Coding Changes for Pulmonary Hypertension in FY2018
This Coding Tip was updated on 12/4/2018
Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
For FY2018, coding for pulmonary hypertension has changed. There are new codes and expanded codes for the Subcategory I27.2.
What is Pulmonary Hypertension?
Pulmonary hypertension is a certain type of high blood pressure that increases the pressure in the pulmonary arteries/lungs and the right side of the heart. Some of the forms of pulmonary hypertension can be serious and over time even fatal. Some forms of pulmonary hypertension are not curable but there are medications that can help lessen the symptoms and improve quality of life. Pulmonary hypertension is different than systemic high blood pressure/hypertension. Pulmonary blood pressure reflects the pressure the heart exerts to pump blood from the heart through the lung arteries. So, this is pressure that is focused on the blood flow in the lungs. Secondary PH is always caused by something else or due to another condition.
Symptoms of Pulmonary Hypertension
Early stages of pulmonary hypertension may have minimal or no symptoms. As the disease progresses, the symptoms become worse.
Common symptoms of Pulmonary Hypertension
- Dyspnea/Shortness of breath
- Fatigue
- Dizziness/syncopal episodes/feeling of being lightheaded
- Chest pain or pressure
- Swelling of ankles, legs and eventually the abdomen
- Cyanosis/bluish color to lips and/or skin
- Palpitation of the heart or racing pulse
- Decreased appetite
- Upper right side abdominal pain
Groups of Pulmonary Hypertension
Pulmonary hypertension is classified into five groups, depending on the cause of the disease.
Group 1: Pulmonary arterial hypertension:
This is the most recognized category of pulmonary hypertension. This type includes both primary and secondary causes. This can be idiopathic (cause unknown) or due to a variety of other conditions/factors. This group can be inherited, drug or toxin induced, caused by connective tissue disease, HIV, liver disease, sickle cell disease, congenital heart disease or by conditions that affect the veins and small blood vessels of the lungs to name a few. There are two ICD-10-CM codes to report for this type of pulmonary hypertension. I27.0 (primary pulmonary hypertension) and I27.21 (secondary pulmonary arterial hypertension).
Group 2: Pulmonary hypertension due to left heart disease:
This category of pulmonary hypertension is caused by failure of the left ventricle or left sided valvular heart disease (mitral and/or aortic valve disease). The most common cause of pulmonary hypertension is left heart disease. ICD-10-CM code I27.22 (pulmonary hypertension due to left heart disease) is reported for this type.
Group 3: Pulmonary hypertension occurring secondary to lung disease and/or hypoxia:
This category of pulmonary hypertension is caused by COPD/emphysema, pulmonary fibrosis, sleep apnea or other sleep disorders and long term exposure to high altitudes. ICD-10-CM code I27.23 (pulmonary hypertension due to lung disease and hypoxia) is reported for this type.
Group 4: Chronic thromboembolic hypertension:
This category is caused by clotting disorders or blood clots in the lung also called pulmonary emboli. ICD-10-CM code I27.24 (chronic thromboembolic pulmonary hypertension) is reported for this type.
Group 5: Other secondary pulmonary hypertension:
This would include causes such as polycythemia vera, essential thrombocytopenia, sarcoidosis, vasculitis, thyroid or glycogen storage disease, kidney disease, anything that presses on the pulmonary artery (like a tumor) or multifactorial. ICD-10-CM code I27.29 (other secondary pulmonary hypertension) is reported for this type.
Unspecified pulmonary hypertension is reported with ICD-9-CM code I27.20.
Sequencing is based on the circumstances of admission or reason for the encounter. When reporting a code from subcategory I27.2, be sure and also report the associated conditions or the adverse effect of the drug/toxin.
As stated above, there is no cure for the disease pulmonary hypertension. But medication/treatment can lessen the symptoms and improve quality of life. Here are a few life style changes that can improve the symptoms:
- Discuss with your MD before taking over the counter medications
- Quit smoking or don’t start to smoke
- Follow a healthy diet-low in fat, cholesterol, sodium and sugar
- Record your weight. If there is a rapid weight gain it may be a sign of worsening
- Stay active
- Avoid the hot tub/sauna
References:
ICD-10-CM Index
AHA Coding Clinic, Fourth Quarter 2017 Pages: 14-15
mayoclinic.org/diseases-conditions/pulmonary-hypertension/symptoms-causes/syc-20350697
heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/What-is-Pulmonary-Hypertension_UCM_301792_Article.jsp
Happy Coding!
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Popular Posts
Coder Q&A with Pat Mac: Coding for Newborn
There seems to be differences of opinions on the issue of a 40w0day gestation Can you clarify if P08.21 should be assigned for 40w0day infant or if it would not be assigned unless the infant’s gestation age was 40w1day or greater?
Query Tip: When to Query for Sepsis
Coders may find situations where a patient is documented as meeting SIRS or sepsis criteria, or has some clinical indicators reflective of possible sepsis, but the physician never documents sepsis as a diagnosis. Should the coder always query for sepsis in these instances?
Coder Q&A with Pat Mac: Principal Dx Selection
In this example, would it be appropriate to code the complication code T82.03XA, Leakage of heart valve prosthesis, initial encounter as the principal diagnosis over the HFpEF (heart failure exacerbation) code?
Find Your Routine: Track Trends to Save Time
We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Kerry Atkins, CDIP, CCS‑P, COC, CPC, CPCO, CPMA, CEMC, COBGC, RMB, Physician Services Consultant at HIA, about the steps she takes to find her routine.
Keeping a Healthy CMI
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Subscribe to our weekly newsletter
Latest News
Coder Q&A with Pat Mac: Coding for Newborn
There seems to be differences of opinions on the issue of a 40w0day gestation Can you clarify if P08.21 should be assigned for 40w0day infant or if it would not be assigned unless the infant’s gestation age was 40w1day or greater?
Query Tip: When to Query for Sepsis
Coders may find situations where a patient is documented as meeting SIRS or sepsis criteria, or has some clinical indicators reflective of possible sepsis, but the physician never documents sepsis as a diagnosis. Should the coder always query for sepsis in these instances?
Coder Q&A with Pat Mac: Principal Dx Selection
In this example, would it be appropriate to code the complication code T82.03XA, Leakage of heart valve prosthesis, initial encounter as the principal diagnosis over the HFpEF (heart failure exacerbation) code?
Find Your Routine: Track Trends to Save Time
We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Kerry Atkins, CDIP, CCS‑P, COC, CPC, CPCO, CPMA, CEMC, COBGC, RMB, Physician Services Consultant at HIA, about the steps she takes to find her routine.
Keeping a Healthy CMI
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Coding Tip: Spinal Procedures Reported in Addition to the Fusion
With the implementation of ICD-10-PCS more codes were developed in order to accurately report procedures. Spinal fusion coding is still a problematic coding issue and at times, even a coder’s nightmare. Coders often report only the code for the fusion thinking that one code would include all of the other procedures that are performed.
Coder Q&A with Pat Mac: Procedure Coding for a Breast Procedure
Answer: I would code 0HPT0NZ for removal of tissue expander from right breast, open and change 0HPT0JZ, removal of synthetic substitute from right breast, open, for removal of the acellular dermal matrix to 0HPT0KZ, Removal of nonautologous tissue substitute from right breast, open approach.
Coding Tip: “Code First” Instructional Notes in ICD-10-CM
There are certain conditions that have instructional notes in the ICD-10-CM tabular/coding conventions that guide the coder in sequencing. This is especially true when the condition has a common manifestation or underlying conditions of a chronic disease. If there is a “code first” note in the tabular, the coder should follow this instruction and sequence the underlying etiology or chronic condition first followed by the manifestation as an additional diagnosis.
Find Your Routine: Tools to Tackle Unpredictable Days
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and reviewers and asked them what steps they take to find a rhythm that works for them. This week, we talked with Meghan Schumacher, CPC, CPMA, Provider Coding Consultant at Health Information Associates, Inc., about the steps she takes to find her routine.
Time is Money
Last year, the Office of Inspector General (OIG) performed an investigation that found, “between 2014 and 2016, Medicare Advantage organizations overturned 75% of their preauthorization and payment denials upon appeal,” which is why, at HIA, we always advise our clients to engage in the appeals process.
Query Tip: Query for Acute Kidney Injury (AKI)
There may be instances where a coder will suspect the patient has acute kidney injury (AKI), but the physician has failed to document the diagnosis. In another scenario, the physician may have made the diagnosis, but there is a question of clinical validity. In either case, a query would be justified.
IPPS Proposed Rule: CC/MCC Designation Changes
Changes to CC/MCC designations included in the proposal could have a potentially dramatic effect on casemix. The presence of a major complication or comorbidity (MCC) or complication or comorbidity (CC) generally is representative of a patient that requires more resources.
It Only Takes One Code
How many times have you heard “it only takes one code to get the claim paid”? With the emphasis on the severity of illness and the move toward value-based reimbursement in today’s healthcare climate, it is more important than ever for coders to report all applicable diagnoses. There are three important pieces: what the provider documents, how to the coder interprets that documentation and codes it, and then how it is extrapolated.
How to Reduce Claims Denials
The reimbursement landscape is already a complicated one – and the highly-complex claims denials process only adds fuel to the fire. A denied claim is one that has been determined by a payor to be in appropriate. Once a coding specialist amends the errors on a rejected claim, they can resubmit it for consideration. The time-intensive process has a significant impact on the cash flow for any setting in the healthcare environment. They are also very costly to appeal.
Query Tip: Query for Clinical Validation
When a practitioner documents a diagnosis that does not appear to be supported by the clinical indicators in the health record, a coder has four choices: (1) Code the diagnosis; (2) Ignore the diagnosis; (3) Generate a query to confirm clinical validation of a diagnosis; (4) Follow the facility’s escalation policy for clinical validation.
$30M Settlement for Medicare Advantage Upcoding
A California-based healthcare services provider and several of its affiliates have agreed to pay $30 million to resolve allegations they submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans, according to the Department of Justice.
National Volunteer Week with HIA
Happy National Volunteer Week! This week we celebrate the impact volunteer work has on building stronger communities. We know that our staff have a positive impact while they’re on the job, and we are proud to share a few ways our #PeopleBehindTheNumbers are taking time to volunteer in their own local communities.
Challenges Facing ASCs in 2019
Scrutiny of coding compliance in the growing ambulatory surgical center (ASC) market has increased in recent years from both Medicare and private payers. This will only increase as the Centers for Medicare and Medicaid Services (CMS) moves towards value-based care.
Coding Tip: Acute Renal/Kidney Failure/Injury vs Dehydration as a Principal Diagnosis
Patients being admitted for acute renal failure due to dehydration have been happening for many, many years now. Typically what happens is a patient gets dehydrated for one reason or another. Once dehydration sets in, it can quickly start to affect many body organs. This can lead to acute renal/kidney failure/injury.
Are you making a $12.5M mistake?
In December 2018, a Pennsylvania for-profit hospital and health system, and its CEO agreed to pay a total of $12.5 million to settle allegations they submitted false claims to Medicare and other federal health care programs for orthopedic surgeries. The settlement resolves allegations that top executives exploited a loophole – AKA modifier 59 – that allowed them to double bill federal healthcare payers for surgeries and ignored coding consultants who advised them that they were improperly billing.
Find Your Routine: Don’t Leave Any Loose Ends
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Zahra Ghahremani, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.
Query Tip: Be Consistent with Query Format
All queries require at least two elements – clinical indicators and a query question. Coders can also include multiple choice options for response or leave the query open-ended for a free text response. The order in which these elements are listed in a query is open to coder or facility preference.
HIA Gives Back to St. Jude, ASPCA in 2018
Giving back is an important part of the HIA mission. Each year, HIA employees take a consensus and choose three National charities to support. Individuals can volunteer a portion of their wages to one of the three organizations. HIA Corporate will match each individual donation up to five dollars. We are proud to share with you our 2018 contribution totals combined with HIA matching funds.
Find Your Routine: Set a Pattern, Follow it
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Donna Cowan, RHIT, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.
Query Tip: Choosing Reasonable Options for Response
The key to choosing reasonable options for a query response is to remember that the query must stand alone. Any clinical indicators supporting the options must be included in the query itself. In this week’s Query Tip, we provide examples of two queries in which the options for response are not reasonable based on clinical indicators used by coder.
Coding Tip: Obstetric Tidbits for PCS
Last week, we looked at tidbits for reporting the ICD-10-CM codes for pregnancy/obstetric records. Now we will look at some for the ICD-10-PCS reporting of these records. In reporting the appropriate ICD-10-PCS codes a coder must know what is included in the terminology of products of conception (POC).
American Heart Month 2019
Chances are, we all know someone affected by heart disease and stroke, because about 2,300 Americans die of cardiovascular disease each day, an average of 1 death every 38 seconds. But together we can change that.
Coding Tip: Pregnancy, Childbirth, and the Puerperium Tidbits
There was a time when coding delivery records was considered simple. Many times, these types of records were given to the newer coders. However, as coding becomes more complex, this is no longer the case. With the implementation of ICD-10-CM came more codes for very detailed and specific issues that occur during pregnancy, childbirth and the puerperium.
Find Your Routine: Work Each Chart the Same Way
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Allison Curry, RHIT, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.