Hypertensive Crisis ICD-10-CM Coding

A hypertensive crisis is a severe increase in blood pressure that can lead to stroke, organ damage, heart attack, and more. The Mayo Clinic defines extreme high blood pressure as  “a top number (systolic pressure) of 180 millimeters of mercury (mm Hg) or higher or a bottom number (diastolic pressure) of 120 mm Hg or higher.”
Hypertensive crisis can be either urgent or emergent. According to the American Heart Association:

Hypertensive Urgency
If your blood pressure is 180/120 or greater, wait about five minutes and try again. If the second reading is just as high and you are not experiencing any other associated symptoms of target organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking, this would be considered a hypertensive urgency. Your healthcare provider may just have you adjust or add medications, but rarely requires hospitalization.
Hypertensive Emergency
If your blood pressure reading is 180/120 or greater and you are experiencing any other associated symptoms of target organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking then this would be considered a hypertensive emergency. Do not wait to see if your pressure comes down on its own, Call 9-1-1.

ICD-10-CM diagnoses codes also distinguish between urgent (category I16.0) and emergency (I16.1) hypertension. Code I16.9 reports hypertensive crisis, unspecified, but its use should be avoided: it is better to query the provider for additional details, if necessary.
For hypertension documented as accelerated or malignant (not hypertensive crisis, urgency, or emergency), look to category I10 Essential  (primary) hypertension.
ICD-10-CM instructions tell us when reporting from category I16, we should, “Code also any identified hypertensive disease (I10-I15). The sequencing is based on the reason for the encounter.”
Additionally, we are to use an additional code(s) to identify:

exposure to environmental tobacco smoke (Z77.22)
history of tobacco dependence (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)

The Coding Clinic, “Connector Hypertensive Crisis, Urgency and Emergency (2016 Vol3, No 4)” provides a coding example:

Question: A 60-year-old male was admitted to the hospital with sudden onset of left-sided weakness, severe headache, slurred speech and left facial droop, and increased blood pressure (260/172). The patient had a chronic hypertension, but was nonadherent with his prescribed medications. CT scan of the head demonstrated right basal ganglia hemorrhage with shift. The patient underwent emergent right frontotemporal craniotomy and evacuation of clot. The provider’s diagnostic statement listed, “Basal ganglia hemorrhage with shift and hypertensive emergency.” What are the appropriate code assignments?
Answer: Assign code I61.0, Nontraumatic intracerebral hemorrhage in hemisphere, subcortical, as the principal diagnosis for the right basal ganglia hemorrhage. Code I16.1, Hypertensive emergency, and code I10, Essential (primary) hypertension, are assigned as additional diagnoses. For the procedure assign the following ICD-10-PCS code: 00C00ZZ Extirpation of matter from brain, open approach

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John Verhovshek

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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