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v1.0.0
ICD-10 Guide
ICD-10 CodesI27.0

I27.0

Billable

Primary pulmonary hypertension

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 I27.0 is a billable code used to indicate a diagnosis of primary pulmonary hypertension.

Key Diagnostic Point:

Primary pulmonary hypertension (PPH) is a rare and progressive disorder characterized by elevated blood pressure in the pulmonary arteries, leading to right heart failure and decreased exercise tolerance. Clinically, patients may present with symptoms such as dyspnea on exertion, fatigue, chest pain, and syncope. The anatomy involved includes the pulmonary arteries, which transport blood from the heart to the lungs for oxygenation. Over time, the increased pressure can lead to vascular remodeling, resulting in further complications such as right ventricular hypertrophy and eventual heart failure. Diagnosis typically involves echocardiography, right heart catheterization, and pulmonary function tests to assess the severity of the condition. Differential diagnoses must be considered, including secondary causes of pulmonary hypertension, such as left heart disease, chronic lung disease, or thromboembolic disease. Accurate diagnosis is crucial for appropriate management and treatment options, which may include medications, lifestyle changes, and in severe cases, lung transplantation.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires specialized testing and differential diagnosis.
  • Treatment complexity: Involves multiple therapeutic options and potential for combination therapies.
  • Documentation requirements: Detailed clinical documentation is necessary to support diagnosis and treatment.
  • Coding specificity: Requires precise coding to differentiate from secondary pulmonary hypertension.

Audit Risk Factors

  • Common coding errors: Misclassification of primary vs. secondary pulmonary hypertension.
  • Documentation gaps: Incomplete clinical notes or lack of diagnostic test results.
  • Billing challenges: Potential denials due to insufficient evidence of medical necessity.

Specialty Focus

Medical Specialties

Pulmonology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Cardiology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Primary pulmonary hypertension significantly impacts patient quality of life and can lead to increased healthcare utilization due to frequent hospitalizations and the need for specialized care. It is a rare condition, but its prevalence is rising, necessitating awareness among healthcare providers. Quality measures focus on early diagnosis and effective management to improve outcomes and reduce morbidity associated with this condition.

ICD-9 vs ICD-10

Primary pulmonary hypertension significantly impacts patient quality of life and can lead to increased healthcare utilization due to frequent hospitalizations and the need for specialized care. It is a rare condition, but its prevalence is rising, necessitating awareness among healthcare providers. Quality measures focus on early diagnosis and effective management to improve outcomes and reduce morbidity associated with this condition.

Reimbursement & Billing Impact

Reimbursement may be affected by the completeness of the clinical picture presented in the medical record. Common denials may arise from insufficient evidence of medical necessity or incorrect coding of related conditions. Best practices include verifying insurance coverage for specific treatments and ensuring that all services rendered are coded accurately to reflect the patient's condition.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by I27.0?

I27.0 specifically covers primary pulmonary hypertension, which is idiopathic in nature and not attributable to other underlying conditions. It is characterized by elevated mean pulmonary arterial pressure without a known cause.

When should I27.0 be used instead of related codes?

I27.0 should be used when the pulmonary hypertension is confirmed to be primary and not secondary to other conditions such as left heart disease or chronic lung disease. Proper diagnostic criteria must be met.

What documentation supports I27.0?

Documentation should include clinical findings, results from echocardiography or right heart catheterization, and any relevant history that rules out secondary causes of pulmonary hypertension.