Starting Oct. 1, coding guidelines will no longer allow for a connection to be assumed between Takotsubo syndrome (I51.81) and hypertension.
The FY2019 guidelines, released July 27, specifically exclude I51.81 from the list of codes that can be assumed connected to hypertension even in the absence of physician documentation and prompting the assignment of I11.- (Hypertensive heart disease) to cover both conditions.
Coming updates to the guidelines cover a wide range of coding topics, including neoplasms, myocardial infarctions, pulmonary hypertension, post-procedural sepsis, substance use, underdosing and burns, as well as a new section covering the use of external cause codes and Z codes in healthcare encounters following hurricanes.
Current guidelines allow any condition coded between I51.4 (Myocarditis, unspecified) and I51.9 (Heart disease, unspecified) to be assumed to be connected to hypertension even without physician documentation. [I.C.9.a.1]
The FY2019 guidelines align with Q2 2018 Coding Clinic guidance, which stated that a patient with Takotsubo syndrome and hypertension should be coded separately with I51.81 and I10 (Essential (primary) hypertension).
But that’s not the only guidelines update that’s connected to Coding Clinic guidance: New guidance was added to section I.B.14, the title of which was changed to “Documentation by Clinicians Other than the Patient's Provider,” to allow for the assignment of codes between Z55 and Z65 (Persons with potential hazards related to socioeconomic and psychosocial circumstances) to be based on clinician, rather than physician, documentation.
The FY2019 coding guidelines align with Q1 2018 Coding Clinic guidance in stating that codes between Z55 and Z65 capture social information and not medical diagnoses and thus can be assigned based on information documented by other clinicians.