Coding Tip: Hypertensive Crisis, Urgency and Emergency Coding
This Coding Tip was updated on 12/10/2018
Kim Carrier
RHIT, CDIP, CCS, CCS – P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
There are now codes to describe hypertensive crisis in ICD-10-CM category I16, Hypertensive Crisis. Coders are now able to differentiate coding of hypertensive urgency (I16.0), hypertensive emergency (I16.1), and hypertensive crisis, unspecified (I16.9). This allows tracking of patients that require immediate treatment for clinically significant hypertension. Accelerated or malignant hypertension would not be coded in this category and would be reported with a code from category I10-I15.
Hypertensive crisis definition:
- Hypertensive crisis—severe rapid increase in blood pressure with the systolic (top number) of 180 (mm Hg) or higher or a diastolic (bottom number) of 120 (mm Hg) or higher. This can lead to damaged blood vessels. The blood vessels become inflamed and can leak fluid or blood. This can result in the heart not being able to pump the blood effectively. When patients present with hypertensive crisis, immediate evaluation is needed to assess the organ function and rule out/in any organ damage and then determine the appropriate treatment. A patient without a diagnosis of hypertension may have a hypertensive crisis with a lower blood pressure documented (lower than 180 systolic or 120 diastolic).
Hypertensive crisis is divided into two categories:
- Urgent—extremely high blood pressure. The patient is not suspected to have any damage to organs
- Emergency—extremely high blood pressure which has caused damage to organs
There are many causes for hypertensive crisis and they can include:
- Medication noncompliance or medication reaction/interaction with other drugs
- Stroke, MI, heart failure, renal failure
- Abdominal aorta rupture
- Eclampsia during pregnancy
Signs and symptoms of hypertensive crisis may include:
- Severe chest pain/Shortness of breath
- Severe headache that may be associated with blurred vision and confusion and/or seizures
- N&V
- Unresponsiveness
- Nose bleed
- Marked anxiety
- Swelling/edema
Hypertensive crisis is uncommon in children but if a sudden severe increase in a child’s blood pressure occurs they will require immediate intervention to prevent harmful consequences.
When the documentation supports a code from the category I16, Hypertensive crisis, the sequencing of codes is based on the circumstances of admission/reason for the admission/encounter. The coder would also code any hypertensive disease (I10-I15).
See example in AHA Coding Clinic, Fourth Quarter 2016, Page: 27.
References:
ICD-10-CM Official Guidelines for Coding and Reporting FY 2017 Page: 48
AHA Coding Clinic, Fourth Quarter 2016, Page: 26-28
Happy Coding!
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Popular Posts
Coding Tip: FY2022 IPPS Final Rule and Unspecified Laterality Diagnosis Codes
Did you get a chance to read the FY2022 IPPS Final Rule? There is an interesting topic that was discussed regarding unspecified ICD-10-CM laterality diagnosis codes, to be exact. In this coding tip we discuss that subject and possible ramifications of it in the coding world.
Part 4: New 2022 Technology Add-On Payments (NTAP)
In Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments. Prepare yourself as this is rather lengthy due to continuation of NTAP that would normally expire.
Part 3: New 2022 IPPS Changes
This is Part 2 of a 4 part series on the FY2022 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented.
Coding Tip: AHA COVID FAQs for ICD-10-PCS & New Technology
Coders are instructed, at this time, to follow the AHA Frequently Asked Questions Regarding ICD-10-CM/PCS Coding for COVID-19. Lately, we have seen missing PCS codes for the new technology drugs that were introduced on August 1, 2020 and thereafter.
Part 2: New 2022 ICD-10-PCS Procedure Code Changes
This is Part 2 of a 4 part series on the FY2022 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented.
Subscribe to our weekly newsletter
Latest News
Coding Tip: FY2022 IPPS Final Rule and Unspecified Laterality Diagnosis Codes
Did you get a chance to read the FY2022 IPPS Final Rule? There is an interesting topic that was discussed regarding unspecified ICD-10-CM laterality diagnosis codes, to be exact. In this coding tip we discuss that subject and possible ramifications of it in the coding world.
Part 4: New 2022 Technology Add-On Payments (NTAP)
In Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments. Prepare yourself as this is rather lengthy due to continuation of NTAP that would normally expire.
Part 3: New 2022 IPPS Changes
This is Part 2 of a 4 part series on the FY2022 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented.
Coding Tip: AHA COVID FAQs for ICD-10-PCS & New Technology
Coders are instructed, at this time, to follow the AHA Frequently Asked Questions Regarding ICD-10-CM/PCS Coding for COVID-19. Lately, we have seen missing PCS codes for the new technology drugs that were introduced on August 1, 2020 and thereafter.
Part 2: New 2022 ICD-10-PCS Procedure Code Changes
This is Part 2 of a 4 part series on the FY2022 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented.
Part 1: New 2022 ICD-10-CM Codes
This is Part 1 of a 4 part series on the FY2022 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis codes and changes.
Coding Tip: Chronic Subsegmental Pulmonary Emboli – One Code or Two?
With the creation and implementation of ICD-10-CM, multiple codes are available to describe the type of pulmonary emboli that occur.
Coding Tip: Hypercoagulable States
Hypercoagulable states are blood disorders that increase the risk of deep vein thrombosis or embolic disease. The state is either inherited or acquired. About 80% of patients with blood clots have been found to have either an inherited or acquired clotting disorder. These blood clots can be lethal and some require life-long therapy. Hypercoagulable state is also known as thrombophilia.
Coding Tip: Do’s and Don’ts of Reporting Encephalopathy
Encephalopathy is a general term and means brain disease, brain damage or malfunction. Physicians often use encephalopathy and altered mental status interchangeably. When coders see this documentation in the healthcare records, they typically need to query the physician for clarification of the diagnosis.
Coding Tip: Spinal Decompression Coding in ICD-10-PCS
Spinal procedure coding can be daunting for coders. The spine itself can be quite complicated anatomically and the procedures done to address spinal conditions can be even more complicated!
Coding Tip: Sneak Peek at FY2022 ICD-10-PCS Procedure Additions and Changes
In June CMS released the final ICD-10-PCS codes for FY2022, which begins October 1, 2021. We are giving you a sneak peek at the changes. HIA will have a full educational module on these changes available later this summer.
Coding Tip: Sneak Peek at FY2022 Proposed DRG Changes
CMS released the IPPS proposed rule on 4/27/21 outlining the proposed changes to the Inpatient Prospective Payment System for FY2022, which begins October 1, 2021. Later this year, sometime in August, CMS will release the Final Rule. Currently CMS is reviewing responses to their proposed rule and will address them in the final rule.
What to Consider Before Your Next Coding Audit
A medical coding audit is a process that includes internal or external reviews of medical coding and billing accuracy, procedures or policies in place, and any other component that affects the medical record documentation. Medical coding audits…
Coding Tip: Anticoagulation and Antiplatelet Therapy
Anticoagulants and antiplatelets are used for the prevention and treatment of blood clots that occur in blood vessels. Oftentimes, anticoagulants and antiplatelets are referred to as “blood thinners,” but they don’t actually thin the blood at all. These drugs slow down the body’s process of making clots. Their main function is to keep the patient’s blood from clotting or turning into solid clumps of cells. These drugs do this by interfering with either fibrin or platelets in the blood.
Coding Tip: Carotid Artery Disease
Carotid artery disease is a vague category that can incorporate many different carotid artery issues. Some physicians may feel that they are being clear the patient has plaque, stenosis, or occlusion of the artery, but in ICD-10-CM the specificity must be included in the documentation.
National Superhero Day: ICD-10 Codes for Superheroes
10 ICD-10 Codes for Superheroes. Superman: T78.2XXA Anaphylactic reaction; substance: kryptonite. Batman: F44.81 Dissociative identity disorder. Robin: F60.7 dependent personality. The Hulk: L30.4 Erythema intertrigo. Wonder Woman: T24.032A Burn of unspecified degree of left lower leg. Black Panther S93.401A Sprain…
Overview of the 2021 E/M Guideline Coding Changes
Practices have not seen many revisions to the Evaluation and Management (E/M) office / outpatient visit guidelines in three decades – until now. As of January 1, there are new E/M coding guidelines. We’ll get to those in a bit, but first let’s look at why they changed.
Coding Tip: Understanding and Reporting Pseudoseizures
Pseudoseizures are a form of non-epileptic seizure. These are difficult to diagnose and oftentimes extremely difficult for the patient to comprehend. The term “pseudoseizures” is an older term that is still used today to describe psychogenic nonepileptic seizures (PNES).
Coding Tip: Coding Bowel Obstruction in ICD-10-CM
With the implementation of ICD-10-CM came different codes and coding rules for many diagnoses. One of these is the coding of bowel obstruction when the patient presents for this condition that is caused by another condition.
Part 5: New 2021 CPT Codes | Modifiers, Category III, Evaluation and Management, etc.
This is Part 5 of a five part series on the new 2021 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
Part 4: New 2021 CPT Codes | Urinary, Nervous, Ocular and Auditory Systems
This is Part 4 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes in the urinary, nervous, ocular and auditory systems. There are 2 new urinary/male reproductive system codes with no revisions or deletions; 3 new female reproductive codes with 2 deletions, 0 new with 4 deleted nervous system codes with 5 revisions; 5 new eye category III codes; and finally a 2 new auditory codes with one deletion.
Part 3: New 2021 CPT Codes | Cardiovascular System
This is Part 3 of a five part series on the new 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
Part 2: New 2021 CPT Codes | Musculoskeletal and Respiratory Systems
This is Part 2 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include some examples to help the coder understand the new codes. There are 0 new musculoskeletal CPT codes added with 0 deletions and 2 major revisions along with an extensive update to arthroscopic loose body removal requirements. For the respiratory system, there were 2 new codes, one code deletion and no revisions.
2020: Year in Review | Coding Education
In January, new CPT codes were released. There were 248 new CPT codes added, 71 deleted and 75 revised. Most of the surgery section changes were in the musculoskeletal and cardiovascular subsections. These included procedures such as skin grafting, breast biopsies, deep drug delivery systems, tricuspid valve repairs, aortic grafts and repair of iliac artery.
Coding Tip: New COVID-19 Codes Effective January 1, 2021
We have seen many updates and changes to COVID-19 (SARS-CoV-2) since the pandemic started. On January 1, 2021 we will see even more changes as outlined in this post. Also the CMS MS-DRG grouper will be updated to version 38.1 to accommodate the changes.
New Technology Add-On Payments (NTAP) For FY2021 – Part 4
In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
New ICD Codes and IPPS Changes for FY2021 (ICD-10-CM Diagnoses changes) – Part 3
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2021.
New ICD Codes and IPPS Changes for FY2021 (ICD-10-CM Diagnoses changes) – Part 2
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
New ICD Codes and IPPS Changes for FY2021 (ICD-10-CM Diagnoses changes) – Part 1
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)