News: Hypertension returns for 2017

by Richard D. Pinson, MD, FACP, CCS

The new MCC/CC lists in 2017 IPPS Final Rule released by CMS on August 2, include several new codes and many new combination codes with greater specificity. Most, however, have little effect on CDI specialists’ daily work. One item, however, hypertension, should raise some interest.

Hypertensive crisis is a non-specific term intended to encompass both hypertensive urgency with marked elevation of blood pressure requiring prompt intervention and the more serious, potentially life-threatening hypertensive emergency requiring immediate aggressive intervention.

ICD-9-CM codes used archaic terms “malignant” and “accelerated” hypertension which were assigned CC status. ICD-10-CM had no codes to identify these serious conditions which were classified as benign essential hypertension and were assigned to code I10 (non-CC).

Thankfully, new codes have been created for these conditions:

• I16.0 (hypertensive urgency) – a non-CC
• I16.1 (hypertensive emergency) – a CC
• I16.9 (hypertensive crisis) – a CC

These additions put hypertension back on the documentation specialist’s agenda. CDI specialists will need to clarify whether a diagnosis of hypertensive urgency (non-CC) actually meets criteria for the more serious circumstances of hypertensive emergency (CC).

Physicians may have to unlearn the terminology for “malignant” and “accelerated” that we’ve been teaching them all these years. Ironically, documentation specialists may now find themselves asking physicians to clarify whether accelerated or malignant hypertensive (non-CC) actually represents a hypertensive crisis or emergency (CC).

There are a few other interesting points for 2017 in regard to capturing MCC/CCs.

• Stenosis of Vascular Stent. There are two new codes, both CCs, for an initial encounter for stenosis of a coronary stent or of a peripheral vascular stent to distinguish them from stenosis of a cardiac or vascular prosthetic device, implant, or graft.
• Acute Pancreatitis. All six of the acute pancreatitis codes have been expanded to specifically identify whether there is no necrosis or infection, necrosis with infection, or necrosis without infection. All of these codes remain MCCs.
• There are no changes to the encephalopathy codes for 2017, and all of them retain their current CC/MCC status. No codes were added to account for hepatic encephalopathy when the patient does not have coma.

Editor’s Note: Dr. Pinson principal of Pinson & Tang LLC, and author of the CDI Pocket Guide wrote this article. Contact him at info@pinsonandtang.com.