Hypertension “With” Heart Involvement in ICD-10-CM

In ICD-10-CM, the word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List.  The classification presumes a causal relationship between the two conditions when linked by these terms in the Alphabetic Index or Tabular List.


The word “with” is sequenced immediately following the main term in the Alphabetic Index and not in alphabetical order.


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. Even in the absence of provider documentation explicitly linking them, these conditions should be coded as related.

Hypertension with heart conditions classified to I50.-or I51.4-I51.9. are assigned a code from category I11, Hypertensive heart disease.  If the provider specifies a different cause then they would be coded separately and not linked. This would be the same if the physician gives another etiology for the CKD. It is an assumed link when NO other cause has been documented.

Example of hypertension and heart involvement:

  • Patient is discharged with final diagnosis of exacerbated CHF, and a secondary diagnosis of hypertension. For this patient, CHF and hypertension would be coded as code I11.0, Hypertensive heart disease with heart failure since the causal relationship is assumed due to the word “with” following the main term in the Alphabetic Index under hypertension.  Since the heart disease falls within the code range of I50.- or I51.4-I51.9 the link would be assumed.  Additional code for the type of heart failure would be assigned as a secondary diagnosis, I50.9.   This was verified at the AHIMA Coding Community meeting in Baltimore, MD on October 15, 2016 by Nelly Leon-Chisen.
  • Patient is discharged with final diagnosis of atherosclerotic heart disease (CAD) with unstable angina and hypertension.  For this patient, the causal relationship would not be linked because the heart disease does not fall within the code range listed for the causal effect to be assumed.  CAD falls within the code range of I25.-.  The code range for the assumed link is I50.- or I51.4-I51.9 only.

ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 Page: 12-13
AHA Coding Clinic, Fourth Quarter 2016, Page: 122-123
AHA Coding Clinic, Fourth Quarter 2017 Pages: 84-86
AHA Coding Clinic, First Quarter 2017 Page: 47

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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.

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