2025 ICD-10-CM code I11
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Circulatory System Diseases - Hypertensive heart disease Diseases of the circulatory system Feed
Hypertensive heart disease;Heart disease resulting from high blood pressure.
Modifiers may be applicable depending on the specific circumstances of service, such as the place of service or the type of procedure performed.Refer to the CMS guidelines and the specific payer's rules for applicable modifiers.
Medical necessity for coding I11 is established by documentation supporting the presence of heart disease directly related to hypertension.This may include evidence of left ventricular hypertrophy, heart failure, angina, or other cardiac complications due to sustained high blood pressure.
Diagnosis and management of hypertension and its cardiac complications; assessment of heart function; treatment of heart failure if present.
In simple words: This code means your heart is having problems because of high blood pressure.High blood pressure over time can damage your heart.Doctors might use this code if you have high blood pressure and your heart isn't working as well as it should.
Hypertensive heart disease (I11) encompasses heart conditions resulting from sustained high blood pressure (hypertension).This includes conditions coded in I50.- or I51.4-I51.7, I51.89, I51.9 due to hypertension.The code is further specified by the presence or absence of heart failure (I11.0 with heart failure; I11.9 without heart failure).Additional codes from category I50 may be used to specify the type of heart failure.
Example 1: A 65-year-old male patient presents with shortness of breath and edema.He has a long history of uncontrolled hypertension.Echocardiogram reveals left ventricular hypertrophy and reduced ejection fraction.I11.0 (Hypertensive heart disease with heart failure) is assigned, along with an additional code from I50 to specify the type of heart failure., A 70-year-old female patient with a history of hypertension undergoes a routine checkup.Physical examination and ECG are unremarkable.I11.9 (Hypertensive heart disease without heart failure) is assigned., A 50-year-old patient with hypertension develops chest pain and is diagnosed with angina.Cardiac catheterization reveals coronary artery disease.I11.9 (Hypertensive heart disease without heart failure) is assigned along with a code for coronary artery disease.
* Thorough history of hypertension, including duration, treatment, and blood pressure readings.* Physical examination findings, including signs of heart failure (e.g., edema, crackles, jugular venous distention).* Electrocardiogram (ECG) findings.* Echocardiogram results.* Cardiac catheterization reports if performed.* Other relevant diagnostic tests (e.g., blood work).* Physician's assessment of the relationship between hypertension and heart condition.
** The causal relationship between hypertension and cardiac involvement is presumed unless the provider explicitly documents otherwise.This code is used for reimbursement and should be supported by complete and accurate documentation.
- Payment Status: Active
- Modifier TC rule: Not applicable to this diagnosis code.
- Specialties:Cardiology, Internal Medicine, Family Medicine
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center, Other