Risk Adjustment:

Pulmonary Hypertension Is Frequently Identified, But Rarely Coded

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HCC Category 85: Congestive Heart Failure

ICD-10 Code: I27.20 Pulmonary Hypertension

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Pulmonary hypertension falls within the hierarchal condition category (HCC) 85: Congestive Heart Failure and may be diagnosed when a patient's pulmonary artery systolic pressure surpasses 36 mmHg on an echocardiogram (ECHO), or their mean pulmonary arterial pressure exceeds 25 mmHg during right heart catheterization (RHC). The ICD-10 Code for PH is I27.20.

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Patients experiencing shortness of breath are frequently assessed using a transthoracic echocardiogram (TTE), with cases of pulmonary hypertension commonly recorded as an elevation in pulmonary artery systolic pressure (PASP). Yet despite the frequency with which pulmonary hypertension appears in echocardiogram results, it is surprisingly uncommon for pulmonary hypertension to be coded in a patient’s electronic health records (EHRs) as a billing diagnosis. 

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Since the identification of pulmonary hypertension corresponds with high mortality and morbidity rates, even mildly elevated pulmonary pressure should be noted as a potential risk factor in pulmonary hypertension diagnostics. Underreporting pulmonary hypertension has historically led to categorical misdiagnoses, delays in clinical referrals, and inappropriate prescribing of medications like pulmonary vasodilators. Physicians should record echocardiogram diagnoses of pulmonary hypertension under the code I27.20 rather than waiting until more severe symptoms present. Coding each PH diagnosis in a patient’s EHR will better inform subsequent analyses and diagnoses as well as facilitate earlier detection and treatment to deter the progression of the condition. Early diagnosis based on ECHO results may also expedite referrals to the appropriate specialists.

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