# new coder needs ICD9 opinion - How is dx for hypertensive diastolic



## ggparker14 (Dec 7, 2010)

How is dx for hypertensive diastolic blood pressure response to exercise listed? Any help is appreciated. Thank you.


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## BCrandall (Dec 9, 2010)

Maybe 796.2? Is there any kind of history?


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## preserene (Dec 9, 2010)

The patient is already hypertensive(from the note we got) and so the 796.2 would not be applicable. It is applicable for transient elevated B.P for otherwise normotensives.
I do not find any suitable code but for settling down with one from Vcode: V81.1
 Any one who could  come out with an appropriate one, we would welcome indeed.


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## ohn0disaster (Dec 9, 2010)

I disagree with preserene about the first comment (s)he made.


preserene said:


> The patient is already hypertensive(from the note we got) and so the 796.2 would not be applicable. It is applicable for transient elevated B.P for otherwise normotensives.



Hypertensive diastolic blood pressure response to exercise does not necessarily mean that the patient has a DX of hypertension. This could just mean that there is another underlying condition, causing diastolic BP to shoot up during exertion. For instance, a study found a correlation with dyslipidemia in this very type of scenerio, in patients who are otherwise healthy normotensive people.

http://www.ncbi.nlm.nih.gov/pubmed/18277829

Without more information, it's not possible to give an indisputably accurate answer. If the patient is KNOWN to be hypertensive, you cannot use 796.2, as was stated by preserene. However, if the patient is normally normotensive, no DX of hypertension made, I would go with 796.2.

Hope this helped?


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## preserene (Dec 9, 2010)

My stance was only for this scenario of statement the code 796.2 would not be applicable , because the parenthetical note itself agrees so.

By the way for clarification of your (ohnO)statement I would like to say: 'The label "Hypertensive" at the outset of the thread could only confer that the patient was already hypertensive. "Hypertensive" be used only if the patient was already established hypertensive. Otherwise should go into the category of "transient, labile" elevated blood pressure, accelerated status of high blood pressure ,stuff like that. If the blood pressure was showing elevated reading at the time of excercise for an otherwise normotensive person, then it not be documented as HYPERTENSIVE; it could be stress induced(Physical activity induced) or other organic/systemic/metabolic reasons contributing to that and so on.
Diastolic, systolic components are to be discussed separately regarding its etiology and it is a big topic by itself. I am not going into that now
However thank you for your response.


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## ohn0disaster (Dec 9, 2010)

Several studies have shown that exaggerated blood pressure response to exercise can predict the development of hypertension and target organ damage, but others did not. Blood-pressure elevation in response to an exercise-induced stimulus is perfectly natural, but on occasion it can be a cause for alarm. Basically, a hypertensive diastolic response to exercise, alone, does not confirm the presence of hypertension in a patient, but should be further investigated.

You're stuck on the word hypertensive, but you need to apply it to the context in which it is being used. I stand by my initial post, so we must agree to disagree.


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