This installment of “In the kNOW” shares information on a specific type of hypertension that affects the pulmonary arteries and right side of the heart known as pulmonary hypertension (PH). This condition can be difficult to diagnosis as its symptoms are similar to other conditions of the heart and lungs.
Pulmonary hypertension can worsen over time and, although there is no cure for pulmonary hypertension, treatments such as medication, or surgery can help. Medications used to treat pulmonary hypertension may include calcium channel blockers to relax blood vessel walls, anticoagulants to prevent clots, and diuretics that remove excess fluid and decrease the burden on the heart. Surgical procedures could include lung or heart-lung transplant, or an atrial septostomy (an opening created between the upper right and left atria of the heart) to reduce the right-sided pressure of the heart.
ICD-10-CM coding for pulmonary hypertension distinguishes between primary and secondary pulmonary hypertension and is further classified by groups.
Group 1 includes primary pulmonary hypertension (I27.0). Other terms that may be used to identify primary pulmonary hypertension include: idiopathic pulmonary arterial hypertension, heritable pulmonary arterial hypertension, or primary pulmonary arterial hypertension (PAH).
Also, included in Group 1 is secondary PAH meaning that the PAH is caused by some other condition. ICD-10-CM code I27.21, identifies secondary PAH, which could be caused by drugs, toxins, or other conditions such as Sjogren’s disease, rheumatoid arthritis, or HIV. There is a “Code also” note at I27.21 directing coding professionals to assign a code for the associated condition or adverse effect of drug or toxin if applicable.
Group 2 pulmonary hypertension is the most common type of PH and is attributable to left heart disease. This could include left heart failure or aortic and/or mitral valve diseases. The applicable ICD-10-CM code for group 2 pulmonary hypertension is I27.22 where there is a “Code also” note to capture the left heart disease if it is known.
Group 3 PH is coded to I27.23 and is due to lung diseases and hypoxia. Again, a “Code also” note requires coding professionals to capture the associated lung disease if it is known. Those lung conditions could be bronchiectasis, pleural effusion, or sleep apnea to name a few.
Group 4 pulmonary hypertension is chronic thromboembolic pulmonary hypertension. If a pulmonary embolism (PE) is applicable to the encounter, a “Code also” note indicates that a code should also be assigned for the PE. I27.24 is the code to assign for group 4 PH. This type of PH may develop as a result of pulmonary arterial wall obstructions that can be seen with tumors or foreign bodies.
Group 5 pulmonary hypertension captures other types of PH and is assigned to code I27.29. Causes may include blood or metabolic disorders, systemic disorders, or multiple factors that cannot be identified. If the associated disorders are specified, another “Code also” note indicates that those conditions should be coded as well. These other conditions could include hyper or hypothyroidism, sarcoidosis, and chronic myeloid leukemia.
As always, there is a code for unspecified pulmonary hypertension at I27.20 should no further information be provided.
As noted in a Coding Clinic from the 4th Qtr. Of 2017, when secondary PH is the result of an associated condition, for example a PE, then the decision for sequencing should be made based on the reason for the encounter.
Now you are In the kNOW!!
About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP, is an HIM professional with over 25 years of experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA, along with being an AHIMA-approved ICD-10-CM/PCS trainer. Dianna has held many positions in HIM and is now an independent coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna is an AHIMA-published author and has volunteered with AHIMA on projects including certification item writing, certification exam development, coding rapid design, and most recently has served on AHIMA’s nominating committee. She is a presenter on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
