Hypertension is commonly known as a silent killer. Although often associated with high blood pressure, hypertension can sometimes occurs as a result of an underlying condition of the kidneys or a hormonal disorder. Patients who present to the emergency department for one condition will have their vitals taken and some are found to have essential hypertension (ICD-9 code 401.9) with the blood pressure readings of “Systolic BP ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg”. “It is estimated that there are nearly 50 million hypertensives in the US with high blood pressure or are taking antihypertensive medications.” One primary reason for elevated blood pressure is a person’s particular lifestyle. Indeed, a sedentary lifestyle can play a major role in the development of high blood pressure, as can smoking, excessive amounts of alcohol, increased use of salt in the diet, or stress. Across the various articles on hypertension, I have seen similar examples of what causes a stress-related increase in blood pressure that is known as “white coat hypertension,” in which the stress of visiting a doctor’s office causes the blood pressure to increase enough to be diagnosed with high blood pressure in someone who has normal blood pressure.
It’s quite unfortunate that in most cases high blood pressure causes no symptoms or is asymptomatic until complications develop in target organs. Moreover, hypertension is one of the major risk factors for coronary heart disease, congestive heart failure, stroke, peripheral vascular disease, kidney failure, and retinopathy.
Hypertension can be classified in many terms, such as: accelerated (significant increase in blood pressure, with some evidence of vascular damage), benign intracranial (Pseudotumor cerebri), cuff-inflation (not representative of true hypertension), drug resistant, essential (hypertension that develops without apparent cause), Goldblatt (hypertension that resembles renal ), intracranial (increased pressure inside the skull, from any cause), malignant (a form of hypertension that progresses rapidly, accompanied by vascular damage), ocular, portal and pregnancy induced.
Primary hypertension has no cure, but treatment (such as lifestyle modification and antihypertensive drug therapy) can modify its course. It is estimated that only 24% of hypertensive patients in the USA have their blood pressure controlled to < 140/90 mm Hg and 30% are unaware that they have hypertension.
Lifestyle modifications as described by the Centers for Medicare and Medicaid Services’ (CMS) Physician Quality Reporting System (PQRS) Quality Measure # 317 and the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) include one or more of the following as indicated:
- Weight Reduction
- Dietary Approaches to Stop Hypertension (DASH) eating plan
- Dietary Sodium Restriction
- Increased Physical Activity
- Moderation in Alcohol (ETOH) Consumption.
Most reference today has identified high blood pressure as mentioned above as “Systolic BP ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg”, but CMS and the PQRS system program have a slightly different measures set for determining what is considered “hypertensive.” CMS quality measure # 317 is for the preventive care and screening for high blood pressure with follow plan documented. CMS measure 317 contains a recommended blood pressure follow-up table and this table indicates that for successful reporting, the blood pressure reading for being considered pre-hypertensive is ≥ 120 mm Hg and ≤ 139 OR ≥ 80 and ≤ 89, with recommendation to re-screen the blood pressure within a minimum of ≥ one day and ≤ 4 weeks AND recommend lifestyle modifications (as mentioned above) OR a referral to the primary care physician or alternative provider.
There is a one-to-one crosswalk (ICD-9 to ICD-10) for essential hypertension, not otherwise specified – see table below, but both ICD-9 and ICD-10 contain many other types of hypertension including, but not limited to, what is shown on the table below.
It is imperative that the provider document exactly what the examination and the diagnostic studies’ findings are, if any, to determine the exact course of action for the condition presented or defined after study. This will also allow the coding staff to select the most appropriate ICD-9 or ICD-10 diagnosis code for reporting on the claim for reimbursement.
- ICD-10-CM, 2014 Complete Draft Code Set, Chapter 9, Pages 569 - 570, Diseases of the Circulatory System (I00 – I99), AAPC, Optuminsight 2013
- ICD-9-CM, 2014, Sixth Edition, 9th Revision, Clinical Modification, Chapter 7, Page 136, Diseases of the Circulatory System (codes 390-459), Editor – Anita C. Hart, Optuminsight August 2013