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ICD-10 Guide
ICD-10 CodesI13.11

I13.11

Billable

Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease

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

Code Description

ICD-10 I13.11 is a billable code used to indicate a diagnosis of hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease.

Key Diagnostic Point:

I13.11 refers to hypertensive heart disease in conjunction with chronic kidney disease (CKD), specifically stage 5 or end-stage renal disease (ESRD), without heart failure. This condition arises when chronic hypertension leads to both cardiac and renal complications. Clinically, patients may present with symptoms related to heart strain, such as chest pain or shortness of breath, alongside signs of kidney dysfunction, including fatigue, fluid retention, and changes in urination patterns. The anatomy involved includes the heart, which may exhibit hypertrophy or other structural changes due to increased workload, and the kidneys, which may show signs of damage or failure due to prolonged hypertension. Disease progression typically involves a gradual decline in kidney function, leading to ESRD, which necessitates dialysis or transplantation. Diagnostic considerations include blood pressure monitoring, renal function tests (e.g., serum creatinine), and imaging studies to assess heart structure and function. Accurate diagnosis is critical to managing both hypertension and CKD effectively, as they are interrelated conditions that can exacerbate each other.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassification of heart failure status.
  • Documentation gaps may arise from insufficient detail on kidney function or hypertension management.
  • Billing challenges can occur if the relationship between hypertension and CKD is not clearly established.

Specialty Focus

Medical Specialties

Nephrology

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

I13.11 has significant clinical implications, as it highlights the intersection of cardiovascular and renal health, which is critical in managing patient outcomes. The prevalence of hypertension and CKD is rising, impacting population health and increasing healthcare utilization. Quality measures often focus on controlling blood pressure and monitoring renal function, making accurate coding essential for effective healthcare delivery and resource allocation.

ICD-9 vs ICD-10

I13.11 has significant clinical implications, as it highlights the intersection of cardiovascular and renal health, which is critical in managing patient outcomes. The prevalence of hypertension and CKD is rising, impacting population health and increasing healthcare utilization. Quality measures often focus on controlling blood pressure and monitoring renal function, making accurate coding essential for effective healthcare delivery and resource allocation.

Reimbursement & Billing Impact

Reimbursement may vary based on the complexity of the case and the payer's policies. Common denials can occur if the relationship between hypertension and CKD is not clearly articulated in the medical record. Best practices include thorough documentation of all clinical findings, treatment plans, and patient education efforts to support the medical necessity of services rendered.

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 I13.11?

I13.11 encompasses hypertensive heart disease and chronic kidney disease stage 5 or ESRD without heart failure. It indicates a significant interplay between chronic hypertension and severe kidney impairment, necessitating careful management of both conditions.

When should I13.11 be used instead of related codes?

I13.11 should be used when a patient has both hypertensive heart disease and stage 5 CKD or ESRD without heart failure. It is crucial to differentiate it from codes that represent isolated hypertension or CKD without heart involvement.

What documentation supports I13.11?

Documentation should include detailed clinical notes on the patient's hypertension history, current blood pressure readings, renal function tests (e.g., creatinine levels), and any imaging studies that demonstrate cardiac or renal abnormalities.