Hypertensive Crisis

Definition:

• HTN: Systolic blood pressure (SBP) of 130mm Hg or more and/or diastolic blood pressure (DBP) of more than 80mm Hg
• HTN Crisis: Generic term to describe hypertensive urgency or hypertensive emergency, typically seen with elevated blood pressure readings of 180/120 or higher
• HTN Urgency: Elevated blood pressure, >180/120, without evidence of end organ damage
• HTN Emergency: Elevated blood pressure, >180/120, with evidence of end organ damage
• Resistant HTN: High blood pressure that does not respond to antihypertensive drugs

Diagnostic Criteria:

Key defining characteristic between HTN Urgency and HTN Emergency is the presence of end organ damage.

Examples of end-organ damage:

• CVA
• MI
• HTN Encephalopathy
• AKI
• Aortic Dissection
• Pulmonary Edema

Coding Considerations

Hypertensive Crisis, Emergency, and Urgency are classified as the code grouping I16 with the instructions to code also any identified hypertensive disease (I10-I15).

Review pertinent Coding Clinics related to HTN such as:

• AHA Coding Clinic, Fourth Quarter 2016, pg. 26 ICD-10-CM New/Revised Codes: Hypertensive Crisis, Urgency and Emergency
• AHA Coding Clinic, Fourth Quarter 2023, pg. 23-25: A new subcategory I1A, other hypertension, has been created with a new code to describe resistant hypertension (RH) (I1A.0). When assigning code I1A.0, the specific type of hypertension, such as essential or secondary hypertension is sequenced first.

CDI Best Practice Considerations

• Hypertensive Crisis (I16.9) and Hypertensive Emergency (I16.1) are both classified as CC’s, whereas Hypertensive Urgency (I16.0) is a non-CC.
• Providers often will document “malignant HTN” and “accelerated HTN,” thinking they have included the required specificity. However, these are outdated terms and index to Essential (primary) HTN (I10), a non-CC. Query for further specificity when diagnostic criteria are met.
• In HTN Emergency patients, ensure the diagnosis of the end-organ damage is documented and supported by clinical indicators in the record. Query for specificity/clarification as needed.
• Review documentation of HTN Urgency closely, querying when criteria is met to specify as HTN Emergency.
• Resistant HTN is not classified as a CC or MCC. Review the record thoroughly for clinical indicators and treatment to support querying for HTN Crisis/Urgency/Emergency when appropriate.

Differentiating between HTN Urgency & Emergency can also be see in treatment regimen:

Review the H&P closely for reported symptoms and physical exam findings. Note that physical exam findings will vary depending on target organ, but some common symptoms & findings to review for include:

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