Making Assumptions About Hypertension and Heart Disease in ICD-10-CM

** This post was reviewed and updated on January 25, 2024. ** 

If you understand the connection between hypertension and heart disease and the ICD-10-CM coding guidelines involving causal relationships, coding for hypertension and heart failure in ICD-10-CM should not be difficult. Test your skill in the “Name That Code” coding challenge to find out what you know. Then, check your answer against the one provided.

Name That Code

Question: A 46-year-old female patient has congestive heart failure due to hypertension. Assign the ICD-10-CM code(s).

Answer: I11.0, I50.9

The Connection Between Hypertension and Heart Disease

Before locating and verifying the correct codes, we must understand a little about hypertension and how it affects the heart. Hypertension is another term for high blood pressure and means the pressure inside the blood vessels is too high. According to MedlinePlus, the heart must work harder to pump against this pressure, eventually leading to the heart muscle’s thickening. Over time, this thickening can result in a lack of oxygen, weakening the heart, and even heart failure.

According to the ICD-10-CM Official Guidelines for Coding and Reporting, the coder may assume a causal relationship between hypertension and heart involvement because the two conditions are linked by the term “with” in the Alphabetic Index. Even if the documentation does not specifically state that the two conditions are related, we can and should code them as related…

Unless the documentation specifically states the conditions are not related.

For hypertension and conditions not explicitly linked by relational terms such as “with,” “associated with,” or “due to” in the classification, provider documentation must link the conditions to code them as related.

Locating and Verifying the Correct Codes

Medical coders must always look up the codes in the Alphabetic Index before verifying them in the Tabular List.

Hypertension With Heart Failure (I11.0)

When looking up Hypertension in the Alphabetic Index, see Hypertension, hypertensive (accelerated) (benign) (essential) (idiopathic) (malignant) (systemic)/with/heart failure (congestive); it takes us to I11.0. In the Tabular, we can verify the correct code as:

I11.0, Hypertensive heart disease with heart failure

Note: There are only two codes listed under category I11, Hypertensive heart disease:

• I11.0, Hypertensive heart disease with heart failure
• I11.9, Hypertensive heart disease without heart failure

Another term listed under I11.0, Hypertensive heart disease with heart failure, is Hypertensive heart failure.

A note under I11.0 states, “Use additional code to identify the type of heart failure (I50.-).”

Congestive Heart Failure (I50.9)

When we go to I50.- in the Tabular, we can see that the codes listed under category I50, Heart failure, are:

• I50.1, Left ventricular failure, unspecified
• I50.20‑I50.23   I50.2, Systolic (congestive) heart failure
• I50.30‑I50.33   I50.3, Diastolic (congestive) heart failure
• I50.40‑I50.43   I50.4, Combined systolic (congestive) and diastolic (congestive) heart failure
• I50.810‑I50.89   I50.8, Other heart failure
• I50.9, Heart failure, unspecified

The documentation in this coding scenario indicates the patient has congestive heart failure. There is no mention of the specific type of heart failure, such as systolic, diastolic, combined, etc. When we go to I50.- in the Tabular, we can see that the appropriate code for congestive heart failure is:

I50.9, Heart failure, unspecified

Another way to find the correct code for congestive heart failure is to look up Failure, failure/heart (acute) (senile) (sudden)/congestive I50.9.

Other terms listed under I50.9, Heart failure, unspecified, include:

• Cardiac, heart or myocardial failure NOS
• Congestive heart disease
• Congestive heart failure NOS

Sequencing: According to the “Code First” note at I50, heart failure due to hypertension (I11.0) should be sequenced before I50.9 for congestive heart failure.

A “Use additional” note at I10-I1A indicates that we need to assign an additional code to identify tobacco use, dependence, exposure to, history of, or occupational exposure to tobacco. However, we cannot code for it here because it wasn’t documented.

Review all the Includes, Excludes1, and Excludes2 notes before making your final code selection.

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If you need more coding practice with causal relationships and their relative coding guidelines, check out the “Name That Code” challenge on hypertension and chronic kidney disease.

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