Internal Medicine Coding Alert

Question: When should I use a malignant hypertension diagnosis? For example, if a patient has a stroke and hypertension, should I report 401.0 or 401.1? What sort of language (other than the word "malignant") should I look for in the dictation for a patient with hypertension to determine if the condition qualifies as benign or malignant?

California Subscriber

Answer: Although 401.x (Essential hypertension) contains three fourth-digit subclassification options, many internal medicine coders use the same code: 401.1 (... benign). In fact, because 401.0 (... malignant) describes a life-deteriorating disease, you will rarely use that code.

In malignant hypertension, the patient's blood pressure rapidly and severely elevates. The high blood pressure causes severe damage that can result in organ failure and/or death if untreated. A patient in such debilitation would require hospitalization. Therefore, 401.0 normally applies to patients in an intensive care unit or an emergency department.

-- Answers for You Be the Coder and Reader Questions were reviewed by Kathy Pride, CPC, CCS-P, a coding consultant for QuadraMed in Port St. Lucie, Fla.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.