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Resource Casual Relationships

ICD-10-CM assumes a cause-and-effect relationship between CKD and HTN, as well as CKD and diabetes.
CKD is most likely related to both the HTN and the diabetes when all three conditions are present. High blood pressure and high blood sugar in the blood vessels can lead to the deterioration of the vessels, which can then cause damage to the kidneys.
CKD should not be assigned as hypertensive if the provider’s documentation specifies that the CKD is not related to the hypertension. Always query if the physician’s documentation seems unclear. Guideline: . Chapter 9: Diseases of the Circulatory System (I00-I99)
a. Hypertension
The classification presumes a causal relationship between hypertension
and heart involvement and between hypertension and kidney
involvement, as the two conditions are linked by the term “with” in the
Alphabetic Index. These conditions should be coded as related even in
the absence of provider documentation explicitly linking them, unless
the documentation clearly states the conditions are unrelated.
For hypertension and conditions not specifically linked by relational
terms such as “with,” “associated with” or “due to” in the classification,
provider documentation must link the conditions in order to code them
as related.


casual relationship.png
ICD-10-CM Guidelines 2022
a. Hypertension
The classification presumes a causal relationship between hypertension and heart
involvement and between hypertension and kidney involvement, as the two
conditions are linked by the term “with” in the Alphabetic Index. These
conditions should be coded as related even in the absence of provider
documentation explicitly linking them, unless the documentation clearly states
the conditions are unrelated.

For hypertension and conditions not specifically linked by relational terms such
as “with,” “associated with” or “due to” in the classification, provider
documentation must link the conditions in order to code them as related.
1) Hypertension with Heart Disease
Hypertension with heart conditions classified to I50.- or I51.4- I51.7,
I51.89, I51.9, are assigned to a code from category I11, Hypertensive
heart disease. Use additional code(s) from category I50, Heart failure, to
identify the type(s) of heart failure in those patients with heart failure.
The same heart conditions (I50.-, I51.4-I51.7, I51.89, I51.9) with
hypertension are coded separately if the provider has documented they
are unrelated to the hypertension. Sequence according to the
circumstances of the admission/encounter.
2) Hypertensive Chronic Kidney Disease
Assign codes from category I12, Hypertensive chronic kidney disease,
when both hypertension and a condition classifiable to category N18,
Chronic kidney disease (CKD), are present. CKD should not be coded as
hypertensive if the provider indicates the CKD is not related to the
hypertension.
The appropriate code from category N18 should be used as a secondary
code with a code from category I12 to identify the stage of chronic
kidney disease.
See Section I.C.14. Chronic kidney disease.
If a patient has hypertensive chronic kidney disease and acute renal
failure, the acute renal failure should also be coded. Sequence according
to the circumstances of the admission/encounter.
3) Hypertensive Heart and Chronic Kidney Disease
Assign codes from combination category I13, Hypertensive heart and
chronic kidney disease, when there is hypertension with both heart and
kidney involvement. If heart failure is present, assign an additional code
from category I50 to identify the type of heart failure.
The appropriate code from category N18, Chronic kidney disease, should
be used as a secondary code with a code from category I13 to identify
the stage of chronic kidney disease.
See Section I.C.14. Chronic kidney disease.
The codes in category I13, Hypertensive heart and chronic kidney
disease, are combination codes that include hypertension, heart disease
and chronic kidney disease. The Includes note at I13 specifies that the
conditions included at I11 and I12 are included together in I13. If a

patient has hypertension, heart disease and chronic kidney disease, then a
code from I13 should be used, not individual codes for hypertension,
heart disease and chronic kidney disease, or codes from I11 or I12.
For patients with both acute renal failure and chronic kidney disease, the
acute renal failure should also be coded. Sequence according to the
circumstances of the admission/encounter.
4) Hypertensive Cerebrovascular Disease
For hypertensive cerebrovascular disease, first assign the appropriate
code from categories I60-I69, followed by the appropriate hypertension
code.
5) Hypertensive Retinopathy
Subcategory H35.0, Background retinopathy and retinal vascular
changes, should be used along with a code from categories I10 – I15, in
the Hypertensive diseases section, to include the systemic hypertension.
The sequencing is based on the reason for the encounter.
6) Hypertension, Secondary
Secondary hypertension is due to an underlying condition. Two codes are
required: one to identify the underlying etiology and one from category
I15 to identify the hypertension. Sequencing of codes is determined by
the reason for admission/encounter.
7) Hypertension, Transient
Assign code R03.0, Elevated blood pressure reading without diagnosis of
hypertension, unless patient has an established diagnosis of hypertension.
Assign code O13.-, Gestational [pregnancy-induced] hypertension
without significant proteinuria, or O14.-, Pre-eclampsia, for transient
hypertension of pregnancy.
8) Hypertension, Controlled
This diagnostic statement usually refers to an existing state of
hypertension under control by therapy. Assign the appropriate code from
categories I10-I15, Hypertensive diseases.
9) Hypertension, Uncontrolled
Uncontrolled hypertension may refer to untreated hypertension or
hypertension not responding to current therapeutic regimen. In either
case, assign the appropriate code from categories I10-I15, Hypertensive
diseases.
10) Hypertensive Crisis
Assign a code from category I16, Hypertensive crisis, for documented
hypertensive urgency, hypertensive emergency or unspecified
hypertensive crisis. Code also any identified hypertensive disease (I10-
I15). The sequencing is based on the reason for the encounter.

11) Pulmonary Hypertension
Pulmonary hypertension is classified to category I27, Other pulmonary
heart diseases. For secondary pulmonary hypertension (I27.1, I27.2-),
code also any associated conditions or adverse effects of drugs or toxins.
The sequencing is based on the reason for the encounter, except for
adverse effects of drugs (See Section I.C.19.e.).


https://provider.amerigroup.com/docs/gpp/ALL_CARE_CausalRelationships.pdf?v=202010300102






 
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