Pulmonary Hypertension Classification Review
April 26th, 2022 - Wyn Staheli, Director of Content
As of October 2017, there were several revisions to pulmonary hypertension coding. Although these codes have been around for quite some time, it would be good to review the rationale behind the reasons for the changes. The following information comes from the request for the code revisions (emphasis added).
|
Pulmonary hypertension (PH) is clinically classified into five groups, based on categories that share similar pathological findings, hemodynamic characteristics and management.
Group 1: Pulmonary Arterial Hypertension (PAH)
PAH is the most widely recognized category of PH, and includes the previously designated Primary Pulmonary Hypertension (PPH). PAH includes idiopathic PAH (IPAH) without an identifiable family history or risk factor, and heritable PAH such as that due to mutations in the bone morphogenetic protein receptor type 2 (BMPR2) gene. PAH also includes a number of secondary causes of PH: drug- and toxin-induced PH, and PH associated with other chronic conditions such as HIV infection, and congenital heart diseases. PAH due to congenital heart disease can be related to defects that cause a left to right shunt. However, over time with PAH, a right to left shunt may develop, in what is referred to as Eisenmenger's syndrome.
Group 2: PH due to left heart disease
This subgroup may be due to left heart failure (systolic or diastolic), or left heart valvular disease that may produce increase in left atrial pressure. Some patients with left heart valvular disease or left heart dysfunction can develop PH as severe as that seen in PAH.
Group 3: PH due to lung diseases and/or hypoxia
In this subgroup, the predominant cause of PH is alveolar hypoxia as a result of lung disease, impaired control of breathing, or residence at high altitude. Among those with pulmonary fibrosis and emphysema, the prevalence of PH is almost 50 percent.
Group 4: Chronic Thromboembolic PH (CTEPH)
Obstruction of pulmonary arterial vessels by thromboemboli, tumors, or foreign bodies can lead to CTEPH.
Group 5: PH with unclear multifactorial mechanisms
This group includes multiple forms of PH for which the etiology is unclear or multifactorial. The subgroups include hematologic disorders such as myeloproliferative disorders and splenectomy; systemic disorders such as sarcoidosis and pulmonary Langerhans cell histiocytosis; metabolic disorders such as glycogen storage disease, Gaucher disease and thyroid disorders; and other conditions that lead to PH.
|
This information can help provide valuable decision-making information on code selection.
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)
COVID Vaccine Coding Changes as of November 1, 2023October 26th, 2023 - Wyn StaheliCOVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M ServicesOctober 11th, 2023 - Wyn Staheli2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....
Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?October 10th, 2023 - Aimee WilcoxWhen EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.
Accurately Reporting Signs and Symptoms with ICD-10-CM CodesOctober 5th, 2023 - Aimee WilcoxCoders often find themselves unsure of when to report a sign or symptom code documented in the medical record. Some coders find their organization has an EHR that requires a working diagnosis, which is usually a sign or symptom, be entered to order a test or diagnostic study or image. Understanding the guidelines surrounding when signs and symptoms should be reported is the first step in correct coding so let's take a look at some scenarios.
The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin ResistanceSeptember 19th, 2023 - Aimee WilcoxDiabetes is a chronic disease that just seems to consistently be increasing instead of improving resulting in a constant endeavor by medical researchers to identify causal effects and possible treatments. One underlying or precipitating condition that scientists have identified as a precipitating factor in the development of diabetes is insulin resistance, which is a known metabolic disorder. As data becomes available through claims reporting, additional code options become possible with ICD-10-CM.
Documenting and Reporting Postoperative VisitsSeptember 12th, 2023 - Aimee WilcoxSometimes we receive questions regarding documentation requirements for specific codes or coding requirements and we respond with information and resources to support our answers. The following question was recently submitted: Are providers required to report postoperative services on claims using 99024, especially if there is no payment for that service? What documentation is required if you are reporting an unrelated Evaluation and Management (E/M) service by the same physician during the postoperative period?
Understanding Gastroesophageal Reflux Disease and ICD-10-CM CodingAugust 22nd, 2023 - Aimee WilcoxGastroesophageal reflux disease or GERD for short, is a disease that impacts millions of Americans on a weekly basis. Symptoms are uncomfortable, as are some of the tests used to diagnose it, but understanding the disease, tests, and treatments helps us better understand how to code the disease using ICD-10-CM codes.
