ICD-10 Coding for Pulmonary Arterial Hypertension(I27.0, I27.21)
Complete ICD-10-CM coding and documentation guide for Pulmonary Arterial Hypertension. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pulmonary Arterial Hypertension
I27.0-I27.9Primary Range
Other pulmonary heart diseases
This range includes codes for various types of pulmonary hypertension, with specific codes for primary and secondary pulmonary arterial hypertension.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I27.0 | Primary pulmonary hypertension | Use when PAH is confirmed as idiopathic or heritable, validated by RHC. |
|
| I27.21 | Secondary pulmonary arterial hypertension | Use when PAH is secondary to another condition, confirmed by RHC. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for pulmonary arterial hypertension
Essential facts and insights about Pulmonary Arterial Hypertension
Primary ICD-10-CM Codes for pulmonary arterial hypertension
Decision Criteria
clinical Criteria
- Confirmed idiopathic PAH via RHC with exclusion of secondary causes
Applicable To
- Idiopathic pulmonary arterial hypertension
- Heritable pulmonary arterial hypertension
Clinical Validation Requirements
- Right heart catheterization showing mean PAP ≥20 mmHg, PAWP ≤15 mmHg, PVR ≥3 Wood units
- Exclusion of secondary causes such as left heart disease, lung disease, or thromboembolism
Code-Specific Risks
- Misclassification if secondary causes are not excluded
- Incorrect use without RHC confirmation
Coding Notes
- Ensure RHC results are documented to support the use of this code.
I27.21 - Secondary pulmonary arterial hypertension
Use when PAH is secondary to another condition, confirmed by RHC.
Applicable To
- PAH due to connective tissue disease
- PAH due to drug use
Excludes
- Primary pulmonary hypertension (I27.0)
Clinical Validation Requirements
- RHC showing mean PAP ≥20 mmHg, PAWP ≤15 mmHg, PVR ≥3 Wood units
- Documentation linking PAH to an underlying condition
Coding Notes
Ensure the underlying condition is clearly documented and linked to PAH.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Pulmonary Arterial Hypertension to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I27.0.
Impact
Clinical: Leads to inappropriate treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always verify if PAH is primary or secondary., Document the underlying cause if secondary.
Impact
Reimbursement: May lead to denied claims due to lack of clinical validation., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Ensure RHC results are documented before coding I27.0.
Impact
Risk of coding PAH without proper clinical validation.
Mitigation Strategy
Implement regular audits of PAH cases to ensure compliance with coding guidelines.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Pulmonary Arterial Hypertension, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pulmonary Arterial Hypertension
Use these documentation templates to ensure complete and accurate documentation for Pulmonary Arterial Hypertension. These templates include all required elements for proper coding and billing.
PAH confirmed by RHC
Specialty: PulmonologyRequired Elements
- RHC results
- Exclusion of secondary causes
- Linkage to underlying conditions if secondary
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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