ICD-10 Coding for Hypertensive Heart Disease(I11.0, I11.9, I13.0)
Complete ICD-10-CM coding and documentation guide for Hypertensive Heart Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hypertensive Heart Disease
I10-I15Primary Range
Hypertensive diseases
This range includes all hypertensive conditions, with specific codes for hypertensive heart disease.
Heart failure
This range is used to specify the type of heart failure associated with hypertensive heart disease.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I11.0 | Hypertensive heart disease with heart failure | Use when hypertension is documented as causing heart failure. |
|
| I11.9 | Hypertensive heart disease without heart failure | Use when hypertension affects the heart but does not cause heart failure. |
|
| I13.0 | Hypertensive heart and chronic kidney disease with heart failure and stage 1-4 CKD | Use when hypertension, heart failure, and CKD stages 1-4 are all present. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for hypertensive heart disease with heart failure
Essential facts and insights about Hypertensive Heart Disease
Primary ICD-10-CM Codes for hypertensive heart disease
Decision Criteria
clinical Criteria
- Documented hypertension with heart failure symptoms
Applicable To
- Hypertensive heart disease with congestive heart failure
Excludes
- Heart failure due to other causes without hypertension
Clinical Validation Requirements
- Echocardiogram showing heart failure
- Blood pressure readings indicating hypertension
Code-Specific Risks
- Incorrectly coding without documented causality
Coding Notes
- Ensure documentation specifies the type of heart failure.
I11.9 - Hypertensive heart disease without heart failure
Use when hypertension affects the heart but does not cause heart failure.
Applicable To
- Hypertensive heart disease without mention of heart failure
Excludes
- Heart failure due to other causes
Clinical Validation Requirements
- Documented hypertension with cardiac involvement
Coding Notes
Ensure cardiac involvement is documented.
I13.0 - Hypertensive heart and chronic kidney disease with heart failure and stage 1-4 CKD
Use when hypertension, heart failure, and CKD stages 1-4 are all present.
Applicable To
- Hypertensive heart and CKD with heart failure
Excludes
- CKD stage 5 or end-stage renal disease
Clinical Validation Requirements
- Documented hypertension, heart failure, and CKD stage 1-4
Coding Notes
Ensure all three conditions are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Personal history of nicotine dependence
Z87.891Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hypertensive Heart Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I11.0.
Impact
Clinical: Leads to incomplete clinical data., Regulatory: Non-compliance with coding specificity requirements., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Always specify heart failure type in documentation.
Impact
Reimbursement: May lead to denied claims if hypertension is not confirmed., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use R03.0 for elevated readings without a diagnosis.
Impact
Reimbursement: May affect reimbursement if unspecified codes are used., Compliance: Non-compliance with specificity requirements., Data Quality: Incomplete clinical data.
Mitigation Strategy
Query provider for specific heart failure type.
Impact
Risk of audit if hypertension and heart failure are not documented as related.
Mitigation Strategy
Ensure clear documentation of causality.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Hypertensive Heart Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hypertensive Heart Disease
Use these documentation templates to ensure complete and accurate documentation for Hypertensive Heart Disease. These templates include all required elements for proper coding and billing.
Chronic systolic heart failure due to hypertension
Specialty: CardiologyRequired Elements
- Ejection fraction
- Blood pressure trends
- Heart failure type
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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