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Special Report: Hypertension Coding
Drug Coding Advisor: Knowledge leads to coding accuracy and better quality
Speak physicians’ hypertension language
(Editor’s note: This second part of a two-part DRG Coding Advisor series on hypertension coding offers suggestions about how coders can overcome obstacles through better understanding of hypertension diagnostics and through use of a hypertensive coding chart.)
If coders better understand hypertension diagnoses, they will be in a better position to ask doctors for more precise information and to code hypertension diagnoses more accurately, says a coding and medical expert.
"Coders need to be diagnosticians," says Kelly Butler, MD, CCS, owner of Dr. Coder & Associates of Murray, UT. "If they aren’t, then they can’t go to the doctor and say, I found these symptoms, and I wonder if this is what you meant to say.’" If coders can speak confidently with physicians in their own language, then physicians are less likely to brush coders’ concerns under the rug, Butler adds. Toward this goal, Butler offers coders this educational advice on hypertension:
1. Understand hypertensive disease.
Hypertension, which affects 50 million Americans, is blood pressure that is 140 or greater systolic and 90 or greater diastolic, Butler says. Of the 50 million Americans with hypertension, only 68% know their diagnosis, Butler adds. "Of those that know, only 53% with a hypertension diagnosis are receiving treatment, and of those receiving treatment, only 27% have their blood pressure under control."
Hypertension patients often won’t take their medication because they don’t feel sick until they do, Butler says.
"With this silent disease, there is progression, and it progresses to the point where it stops being silent and starts to scream," Butler explains. "And it screams by congestive heart failure, renal failure, and blindness."
2. Know the stages of hypertension.
The stages of hypertension are as follows:
Below hypertension, there is high normal blood pressure, which is 130-139 systolic and 85-89 diastolic. Blood pressure readings optimally are less than 120 systolic and less than 80 diastolic, although the normal range extends up to 129 systolic and 84 diastolic.
"When you hear mild,’ moderate,’ or severe,’ you know their blood pressure is out of control," Butler says. "But that’s all it says, because a coder cannot assign accelerated hypertension or malignant hypertension codes just based on a blood pressure reading."
Also, although hypertension coding permits a code for benign hypertension, that code is so rarely used that it should be a red flag to coders if the word benign’ appears in a physician’s notes, Butler says. (Click here, to see chart on hypertensive disease.)
3. Know the hypertensive emergencies.
Proper coding also depends on which of the following hypertensive emergencies apply: