In a yearly checkup case with a history of St. Jude mitral valve replacement and moderate pulmonary hypertension, what is the primary diagnosis code?

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The main idea here is identifying the condition that explains the encounter. In an annual checkup for a patient with a known chronic issue, the active problem to address is the pulmonary hypertension, so the primary diagnosis would be the code for that condition: pulmonary hypertension, unspecified. The history of a prosthetic mitral valve is important to document, but it’s a current status item rather than the main reason for the visit, so it’s captured separately as presence of a prosthetic heart valve. If anticoagulation is being used, that would be a secondary code as well, but it does not replace the primary diagnosis.