ICD-10 Diagnosis Codes for Documenting Hypertensive Crisis

A hypertensive crisis occurs when the blood pressure rises quickly and severely with readings of 180/120 or greater. This condition affects more than 500,000 Americans each year, or approximately 1% of hypertensive adults. Uncontrolled hypertensive crisis may lead to stroke, heart attack, heart failure, kidney failure, and rupture of your body’s main artery (aorta), among other health issues. Physicians who treat hypertensive crisis rely on medical billing companies to code the condition.

ICD 10 Code for Hypertensive Crisis

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• I16 is the ICD 10 code for hypertensive crisis. A hypertensive crisis is classified into two: hypertensive urgency and hypertensive emergency.

Hypertensive Urgency

A hypertensive urgency is a condition in which blood pressure is extremely high (for instance ≥180/≥110 mmHg) with minimal or no symptoms and no signs or symptoms indicating acute organ damage.

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Code for Hypertensive Urgency

• I16.0 – hypertensive urgency

Hypertensive Emergency

Hypertensive emergency or malignant hypertension is a condition in which blood pressure is very high (e.g.: 180/120 or greater) without potentially life-threatening symptoms of target organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking and signs indicative of acute impairment of one or more organ systems. This condition rarely requires hospitalization, but the provider may adjust or add medications.

Code for Hypertensive Emergency

• I16.1 – hypertensive emergency

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Code I16.9 is used for hypertensive crisis, unspecified, but its use should be avoided.

Use of Tobacco or Exposure to Tobacco in Individuals with Hypertension

All of the hypertensive crisis codes require an additional ICD-10 code if the patient is a current or former tobacco user.

• Z77.22 – exposure to environmental tobacco smoke
• Z87.891 – history of tobacco dependence
• Z57.31 – occupational exposure to environmental tobacco smoke
• F17.2 – tobacco dependence
• Z72.0 – tobacco use

AAPC.com recently gave a good example of hypertensive crisis coding in its recent blog. This case involved a 60-year-old male patient had chronic hypertension, but was non-adherent with his prescribed medications. The patient had severe headache, sudden onset of left-sided weakness, slurred speech and left facial droop. His blood pressure stood at 260/172. A CT scan taken of the head showed right basal ganglia hemorrhage with shift. Emergent right fronto-temporal craniotomy and evacuation of clot was performed on the patient. The provider’s diagnosis was “Basal ganglia hemorrhage with shift and hypertensive emergency.”

In this case, code “I61.0, Nontraumatic intracerebral hemorrhage in hemisphere, subcortical,” has to be reported for the principal diagnosis for the right basal ganglia hemorrhage. Additional diagnosis codes to assign include “I16.1, Hypertensive emergency, and code I10, Essential (primary) hypertension”. For the procedure the ICD-10-PCS code: “00C00ZZ Extirpation of matter from brain, open approach,” should be assigned.

Medical coding and billing can be rather challenging. However, medical coding services offered by reliable medical billing and coding companies can help physicians working in this specialty submit their claims with the latest accurate medical codes. This is essential to avoid claim denials and ensure optimal reimbursement.

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