Patient: Five months pregnant with high blood pressure
Diagnoses as assigned by the Physician:
1. Benign Hypertension
2. Ectopic Pregnancy
ICD-9: Is it 401.9 and V22.2?
ICD-10: Is it I10 and O00.9?

Correct Codes
401.9 is not the only code used for hypertension and V22.2 (incidental pregnancy) is not the correct code for mid-term or second trimester pregnancy in this case.

642.03: Benign essential hypertension complicating pregnancy is the correct ICD-9 code for this scenario. Per ICD-9 coding conventions, when the patient is pregnant the pregnancy complication code should be selected as the primary code.

The correct code choice when coding under ICD-10 would be O16.2, unspecified maternal hypertension, second trimester.

Hypertension
Hypertension is a common, often asymptomatic disorder characterized by elevated pressure persistently exceeding 140/90 mm Hg. Essential hypertension, the most frequent kind, has no single identifiable cause, but a high sodium level in serum, hypercholesterolemia, and a family history in high blood pressure increases the risk of the disorder. Known causes of hypertension include adrenal disorders, toxemia of pregnancy and chronic glomerulonephritis. Glomerulonephritis involves the inflammation of the tiny filters in the kidneys - glomeruli - which remove excess fluid, electrolytes and waste from the bloodstream and pass them through ther urine. If diabetes is the cause for glomerulonephritis then it is secondary glomerulonephritis.

The ICD-9 Hypertension Table has a complete breakdown of hypertension as it relates to the patient’s current condition. Co morbid diseases, a disease co-existing with the primary disease (i.e., the primary disease could be cancer and the co morbid disease emphysema) of hypertensive related conditions can include renal failure, cardiovascular disease, pregnancy related problems (edema, heart disease, pre-eclampsia, eclampsia, fetus or newborn) and others. Hypertension can be “due to” or “secondary due to” many conditions. All of the above conditions have their own specific codes and the coders should familiarize themselves with this table in order to code the most specific code for the condition.

ICD-10 hypertension is located in Chapter 9, Diseases of the Circulatory System (I00 – I99.9). It covers hypertension with heart disease, kidney disease, cerebrovascular disease, retinopathy, hypertension (secondary, transient, controlled and uncontrolled), artery disease, angina, and intra-operative and post-procedural and other diseases of the circulatory system.

Pregnancy related codes are located in Chapter 15 of the ICD-10 code book (O00 – O9A.53). Any condition that may be considered a complication, a disorder or other condition that is related to affecting the pregnancy will be found in this section of the ICD-10 code set book.

References
ICD-9-CM, Volumes 1, 2 & 3,
ICD-10 Draft Code Set Book
Taber’s Cyclopedic Medical Directory, 18th edition
Merck Online Manual

This commentary is a summary prepared by McKesson’s Business Performance Services division and highlights certain changes, not all changes, in 2014 CPT® codes relating to the specialty of emergency medicine and emergency medical services. This commentary does not supplant the American Medical Association’s current listing of CPT® codes, its documentation in the annual CPT Changes publications, and other related publications from American Medical Association, which are the authoritative source for information about CPT® codes. Please refer to your 2014 CPT® Code Book, annual CPT® Changes publication, HCPCS Book and Payer Bulletins for additional information, including additions, deletions, changes and interpretations that may not be reflected in this document.

CPT is a registered trademark of the American Medical Association (“AMA”). The AMA is the owner of all copyright, trademark and other rights to CPT® and its updates. 

Author - Male

About the author

Robert Bunting, CPC, CPC-H, CHC, CEDC, CEMC, CAC is Compliance Director – Emergency Medicine, McKesson Business Performance Services.