Q&A DIAGNOSIS CODE for "secondary hypertension due to coarctation of aorta".

[SHARI]

I am confused on which chapter guideline to use to code this. The secondary HTN guideline says I need 2 codes, but the congenital anomaly guideline says to only code the anomaly if the condition is inherent to it. So, is secondary HTN inherent to coarctation of the aorta? Or is the "stenosis" of the aorta (which I would not code) considered the inherent condition, causing the SECONDARY HTN (which I would code)?
Thanks,
Shari, RN,CPC-A

 

[Alicia Scott]

First I always start with a definition to make sure I understand what is going on when I come up with a coding delima.
Coarctation of the aorta is a constriction of the aorta located near the ligamentum arteriosum and the origins of the left subclavian artery. This condition may be associated with other congenital disease. The mean age of death for persons with this condition is 34 years if untreated, and is usually due to heart failure, aortic dissection or rupture, endocarditis, endarteritis, cerebral hemorrhage, ischemic heart disease, or concomitant aortic valve disease in uncomplicated cases. Symptoms may not be present in adults. Diminished and delayed pulses in the right femoral artery compared with the right radial or brachial artery are an important clue to the presence of a coarctation of the aorta, as are the presence of a systolic murmur over the anterior chest,bruits over the back, and visible notching of the posterior ribs on a chest x-ray. In many cases a diagnosis can be made with these findings. Two-dimensional echocardiography with Doppler interrogation is used to confirm the diagnosis. Surgical repair and percutaneous intervention are used to repair the coarctation; however, hypertension may not abate. Because late complications including recoarctation, hypertension, aortic aneurysm formation and rupture, sudden death, ischemic heart disease, heart failure, and cerebrovascular accidents may occur, careful follow-up is required. http://www.ncbi.nlm.nih.gov/pubmed/15187499

CC/MCC Status: CC
When used as a secondary diagnosis, this code (747.10) DOES create a Complication/Comorbidity (CC) - IF the principal diagnosis does not appear in the 'Principal Diagnosis Exclusions' list below (otherwise it is treated as a non-CC).
Principal Diagnosis Exclusions (for 747.10 as Secondary Diagnosis)
When used as a secondary diagnosis with one of the following principal diagnosis codes, this code (747.10) does NOT create a CC or MCC (is excluded):
747.10 Coarctation of aorta747.11 Interrupt of aortic arch747.20 Cong anom of aorta NOS
747.21 Anomalies of aortic arch747.22 Aortic atresia/stenosis747.89 Circulatory anomaly NEC
747.9 Circulatory anomaly NOS759.7 Mult congen anomal NEC759.89 Specfied cong anomal NEC
Secondary Diagnosis Exclusions (for 747.10 as Principal Diagnosis)

When this code (747.10) is used as a principal diagnosis, the following secondary diagnosis codes do NOT create a CC or MCC (are excluded):
747.10 Coarctation of aorta747.11 Interrupt of aortic arch747.20 Cong anom of aorta NOS
747.21 Anomalies of aortic arch747.22 Aortic atresia/stenosis747.29 Cong anom of aorta NEC
747.9 Circulatory anomaly NOS

With all that being said!​

405.9 Secondary hypertension; unspecified
Note: Use these codes for elevated systemic blood pressure caused by another underlying disease or condition when the type of essential hypertension is not identified as either benign or malignant.

405.99 - Secondary hypertension; unspecified, other

401-405Excludes: that complicating pregnancy, childbirth, or the puerperium (642.0-642.9)
that involving coronary vessels (410.00-414.9)

Confirm that the secondary htn is NOT Malignant or Benign because you do want to be as specific as possible. 405.99 is a catch all and payers don't like that.

SO!!!!
I would go with 747.10, 405.99

Unless you can get it specified as 405.09 or 405.19