ICD-10 Coding for Uncontrolled High Blood Pressure(I10, I16.0)
Complete ICD-10-CM coding and documentation guide for Uncontrolled High Blood Pressure. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Uncontrolled High Blood Pressure
I10-I15Primary Range
Hypertensive diseases
This range includes essential hypertension and hypertensive heart and renal diseases, which are relevant for uncontrolled hypertension.
Elevated blood pressure reading, without diagnosis of hypertension
Used for elevated blood pressure readings when hypertension is not diagnosed.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I10 | Essential (primary) hypertension | Use when hypertension is not specified as secondary or with organ damage. |
|
| I16.0 | Hypertensive urgency | Use when severe hypertension is present without organ damage. |
|
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 uncontrolled high blood pressure
Essential facts and insights about Uncontrolled High Blood Pressure
Primary ICD-10-CM Codes for uncontrolled high blood pressure
Decision Criteria
clinical Criteria
- BP ≥140/90 despite treatment
documentation Criteria
- Document therapeutic regimen and response
Applicable To
- Hypertension
Clinical Validation Requirements
- BP ≥140/90 despite treatment
- Documentation of therapeutic regimen
Code-Specific Risks
- Ensure documentation specifies 'uncontrolled' if applicable.
Coding Notes
- Ensure 'uncontrolled' is documented if applicable.
I16.0 - Hypertensive urgency
Use when severe hypertension is present without organ damage.
Applicable To
- Severe hypertension without organ damage
Excludes
- Hypertensive emergency (I16.1)
Clinical Validation Requirements
- BP ≥180/120 without end-organ damage
Coding Notes
Document absence of organ damage.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Elevated blood pressure reading, without diagnosis of hypertension
R03.0Differential 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 Uncontrolled High Blood Pressure to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I10.
Impact
Clinical: Inaccurate treatment assessment, Regulatory: Potential audit issues, Financial: Impact on reimbursement
Mitigation Strategy
Use EHR templates, Regularly update medication lists
Impact
Reimbursement: Incorrect DRG assignment, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate clinical data
Mitigation Strategy
Use I11.0 if heart failure is due to hypertension.
Impact
Incorrect coding of hypertension can lead to audits.
Mitigation Strategy
Ensure thorough documentation of BP readings and treatment response.
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 Uncontrolled High Blood Pressure, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Uncontrolled High Blood Pressure
Use these documentation templates to ensure complete and accurate documentation for Uncontrolled High Blood Pressure. These templates include all required elements for proper coding and billing.
Primary Care Visit for Uncontrolled Hypertension
Specialty: Primary CareRequired Elements
- BP readings
- Medication adherence
- Target organ assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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