Diseases of the Circulatory System

ICD-10 Code: I15.0

Renovascular Hypertension

Renovascular hypertension is secondary hypertension caused by renal artery stenosis (RAS), typically due to atherosclerotic disease or fibromuscular dysplasia, resulting in reduced renal perfusion and activation of the renin-angiotensin-aldosterone system (RAAS).

Clinical Information

Renovascular hypertension accounts for approximately 1-5% of all hypertension cases but is the most common curable form of secondary hypertension. It results from hemodynamically significant stenosis (typically >70%) of one or both renal arteries, leading to decreased renal perfusion pressure. The affected kidney(s) respond by increasing renin secretion, triggering RAAS activation and systemic vasoconstriction. The two main causes are: (1) Atherosclerotic renal artery stenosis (ARAS)—accounts for 90% of cases, typically in older adults (>50 years) with cardiovascular risk factors, usually affects proximal renal artery; (2) Fibromuscular dysplasia (FMD)—accounts for 10%, typically in younger women (<40 years), affects mid-to-distal renal artery with characteristic "string of beads" appearance on imaging. Clinical clues suggesting renovascular hypertension include: sudden onset or worsening of hypertension (especially age <30 or >55), resistant hypertension despite 3+ medications, flash pulmonary edema, unexplained azotemia after ACE inhibitor/ARB initiation, abdominal bruit, asymmetric kidneys on imaging, or renal artery atherosclerosis on other vascular imaging. Diagnosis confirmed by renal artery imaging (CT angiography, MR angiography, or renal Doppler ultrasound).

Coding Guidelines

  • 1Use I15.0 for hypertension explicitly documented as caused by renal artery stenosis or renovascular disease
  • 2This is secondary hypertension—do not code I10 (essential hypertension) when renovascular etiology is established
  • 3Consider additional code for underlying cause: atherosclerosis (I70.1), fibromuscular dysplasia (I77.3)
  • 4If chronic kidney disease is also present, code separately (N18.x) unless provider links it to the renovascular disease
  • 5For hypertension with renal artery stenosis status-post revascularization (angioplasty/stent), continue using I15.0 if hypertension persists
  • 6Document laterality if specified: unilateral vs. bilateral renal artery stenosis

Common Uses

  • Nephrology visit for patient diagnosed with renal artery stenosis causing hypertension
  • Post-renal angiography encounter documenting 80% right renal artery stenosis as cause of resistant hypertension
  • Hypertension evaluation revealing fibromuscular dysplasia on CT angiography
  • Follow-up after renal artery stenting procedure for renovascular hypertension
  • Vascular surgery consultation for surgical revascularization consideration in renovascular HTN
  • Hospital admission for hypertensive emergency found to have bilateral renal artery stenosis

Related ICD-10 Codes

I15.1Hypertension secondary to other renal disorders
I15.2Hypertension secondary to endocrine disorders
I15.8Other secondary hypertension
I15.9Secondary hypertension, unspecified
I70.1Atherosclerosis of renal artery
I77.3Arterial fibromuscular dysplasia
I10Essential hypertension (do not use with I15.0)

Documentation Requirements

  • Provider must explicitly document causal relationship: 'renovascular hypertension,' 'hypertension due to renal artery stenosis'
  • Document imaging findings: percent stenosis, affected artery (right, left, or bilateral), imaging modality used
  • Specify etiology if known: atherosclerotic vs. fibromuscular dysplasia vs. other cause
  • Include blood pressure readings (especially if resistant to multiple medications)
  • Document revascularization procedures if performed: percutaneous angioplasty, stenting, surgical bypass
  • Note response to treatment: blood pressure improvement after revascularization, medication requirements

Real-World Coding Examples

52-year-old presents with resistant hypertension (BP 180/105 despite 4 medications). CT angiography shows 85% stenosis of left renal artery due to atherosclerotic plaque. Nephrologist documents: 'Renovascular hypertension secondary to atherosclerotic renal artery stenosis.' Diagnosis: Renovascular hypertension (I15.0), Atherosclerosis of renal artery (I70.1). Plan: Renal artery stenting.

28-year-old woman with new-onset severe hypertension. MR angiography reveals 'string of beads' appearance of right renal artery consistent with fibromuscular dysplasia. Diagnosis: Renovascular hypertension (I15.0), Arterial fibromuscular dysplasia (I77.3).

Follow-up visit 3 months after right renal artery stenting. Patient's BP improved from 190/110 to 135/80 on 2 medications (down from 4). Assessment: 'Renovascular hypertension, improved after revascularization.' Diagnosis: I15.0.

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Medical coding for Diseases of the Circulatory System