So Long, Hypertensive Heart Disease Rule … You’ll Be Missed (Kind Of)

goodbye 2016 ICD10 official guidelines

Seeing the ICD-10 Official Guidelines for hypertension change for 2017 felt like the end of an era. There was something fun about knowing you should assume a relationship between hypertension and chronic kidney disease, but NOT between hypertension and heart disease.

The updated OGs, which went into effect Oct. 1, 2016, changed that, going for a more consistent and easier to remember coding rule that you should assume a relationship in both cases. (I’ll have to find another not-so-obvious rule to get my coder-geek jollies. CPT® definition of “initial infusion,” I’m looking at you!*)

For those of you who have the old hypertension rule ingrained in your head, here’s a quick review of the update so you can be sure you’re choosing the right codes for your patients.

Old Way: Heart This Way, CKD That Way

Section I.C.9.a of the 2017 OGs covers hypertension coding. The OGs before 2017 had these rules:

  • If the documentation didn’t identify a relationship between hypertension and heart disease, you had to code each condition separately. Using I11.- (Hypertensive heart disease) was inappropriate without a stated causal relationship.
  • For hypertension and chronic kidney disease (CKD), using a code from I12.- (Hypertensive chronic kidney disease) was appropriate even without any documentation that the two were connected.

New Way: Heart Catches Up With CKD

The updated guidelines say that you should presume a causal relationship between hypertension and heart disease, and between hypertension and CKD. The reason is that the ICD-10 Index links those conditions with the term “with,” and the 2017 OGs state that you should presume a relationship any time the Index links conditions using terms like “with,” “associated with,” and “due to.”

Important: If documentation lists a different cause, then you should code hypertension separately from the heart disease and CKD. In other words, you should assume a relationship only if there is no documentation contradicting that assumption.

Bonus OG: Know How to Sequence Hypertensive Crisis?

As long as we’re talking about hypertension OGs, I want to mention a 2017 addition related to new codes in category I16.- (Hypertensive crisis). The OGs mention the ICD-10 note with the category to “Code also any identified hypertensive disease (I10-I15).” You should sequence the codes with the reason for the encounter first.

How About You?

Will these changes affect your coding? When it comes to the hidden rules and secret language of coding, do you have any favorites? Do you have any that you wish would change to keep things simple?


* An “initial infusion” is the first one, right? CPT® doesn’t make it that straightforward. For physician coding, CPT® guidelines define an “initial infusion” as the one that’s the main reason for the encounter, even if it’s not the first infusion the patient gets. Consequently, you often have to use a “sequential infusion” code to report the first infusion of the encounter!


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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2 Comments For This Post

  1. Elizabeth Says:

    Great article and love your style of writing. Thank you for sharing this very important information.


  2. Deborah Marsh Says:

    Thanks very much, Elizabeth!

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