Cardiology Coding Alert
Sort Out Symptoms of Malignant Hypertension
Question: What symptoms qualify as malignant hypertension? Are there specific diastolic/systolic readings? What are the appropriate diagnosis codes? If a specified heart condition (428.0-428.9, Heart failure; 429.0-429.3, Ill-defined descriptions and complications of heart disease such as myocarditis, myocardial degeneration, unspecified cardiovascular disease, and cardiomegaly; and 429.81-429.9, Other ill-defined heart diseases) coexists with hypertension, but a cause-and-effect relationship does not exist or has not been adequately documented, apply two codes: one for the hypertension and one for the heart condition. You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.
North Carolina Subscriber
Answer: Malignant hypertension is a severe form of acute hypertension that results from an abrupt rise in blood pressure. If left untreated, malignant hypertension can damage the blood vessels in the eyes, kidneys, brain and heart. Your cardiologist will commonly document diastolic pressures as high as 130 mmHg or more. You'll also find a prior history of hypertension, especially hypertension resulting from kidney disorders.
Some symptoms of malignant hypertension are blurred vision, headache, change in mental status, chest pain, shortness of breath, cough, decreased urinary output, nausea and vomiting, seizure, weakness in extremities, or numbness of extremities.
The key to correct coding for hypertension is not in establishing a clear clinical definition of malignant hypertension but in educating physicians that--for reporting purposes--they must follow ICD-9's definition of malignant, regardless of the clinical definition. According to ICD-9, malignant hypertension is a severe form of hypertension, wherein the patient's blood pressure reading is consistently higher than 120 diastolic and is difficult to treat.
The codes for malignant hypertension are:
When coding hypertensive cerebrovascular disease, you'll need two codes to describe the condition fully. Assign the first code from the 430-438 series (Cerebrovascular disease), along with the appropriate hypertension code (401-405).
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Sort Out Symptoms of Malignant Hypertension
Question: What symptoms qualify as malignant hypertension? Are there specific diastolic/systolic readings? What are the [...]
