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ICD-10 codes you should know

05 Aug 2018

How to code hypertensive crisis

By: Patti Moore BSN, RN, CCDS

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The induction of ICD-10 brought with it new terminology and shelved some older documentation terms. Specifically, in regards to quality of hypertension, the terms “malignant” and “accelerated” no longer exist as qualifiers for hypertension.

Welcome “hypertensive crisis” as the new ICD-10 terminology. Hypertensive crisis is defined by a severe elevation in blood pressure — which is complicated by organ dysfunction (or imminent dysfunction). There are two categories of hypertensive crisis: hypertensive urgency and hypertensive emergency.

  • Hypertensive urgency is evidenced by marked elevation in blood pressure with symptoms such as headache, dyspnea or chest pain, but without clear, end-organ dysfunction; it is treated with oral antihypertensives with a goal to decrease blood pressure over several hours.
  • Hypertensive emergency is evidenced by more severe, potentially life-threatening blood pressure elevation with end-organ dysfunction; it is treated with intravenous antihypertensives, as it requires an immediate reduction in blood pressure readings.

End-organ dysfunction may include acute kidney injury, hypertensive encephalopathy, stroke, seizure, unstable angina, heart failure or myocardial infarction.

When documenting hypertension please include type and any causal relationship. Here are two examples:

  • Blood pressure recordings of 190/80 with associated headache, treated with an oral antihypertensive could be documented as ‘hypertensive crisis with urgency’ or simply ‘hypertensive urgency.’
  • Blood pressure recordings of 190/80 with associated headache, AKI and treated with IV antihypertensive could be coded as ‘hypertensive crisis with emergency’ or simply ‘hypertensive emergency.’