Accelerated Vs. Malignant Hypertension
Some time ago, I had a physician explain accelerated and malignant hypertension to us and it was explained as 2 different conditions; Accelerated being rapid increasing hypertension and malignant being potential or probable organ damage. Now, another physician has shared with one of the CDS that he had been told at another hospital, not to use the term accelerated htn because it was the same as malignant which has organ involvement.
Can anyone clarify this for us? When we look up the definitions, it seems they are used interchangeably. Thanks, in advance, for the feedback.
Karen
Karen McKaig, BSN, RN, CCM, CPUR, CCDS
Case Manager
Clinical Documentation Specialist
Baxter Regional Medical Center
Mountain Home, AR 72653
870-508-1499
kmckaig@baxterregional.org
Can anyone clarify this for us? When we look up the definitions, it seems they are used interchangeably. Thanks, in advance, for the feedback.
Karen
Karen McKaig, BSN, RN, CCM, CPUR, CCDS
Case Manager
Clinical Documentation Specialist
Baxter Regional Medical Center
Mountain Home, AR 72653
870-508-1499
kmckaig@baxterregional.org
Comments
Both malignant and accelerated HTN are types of hypertensive emergencies. Both result in target organ damage (Ex: CHF, chest pain, abnormal renal function, proteinuria, and altered mental status). However, malignant hypertension MUST also have papilledema present. I have seen slightly different parameters for BP.
Malignant (SBP>180, DBP>120)
Accelerated (SBP 160-179, DBP 100-109)
I'm interested as to what others have been told....
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Uncontrolled: is NOT malignant
Accelerated: significant increase over baseline B/P associate with target organ damage
Malignant: as above plus papilledema on fundoscopic exam
HTN urgency: no evidence of target organ damage; severely increased B/P S>220 OR diastolic >120
HTN emergency: requires immediate treatment; increased B/P with target organ damage
Charlene Thiry RN, BSN, CPC, CCDS
Clinical Documentation Specialist
Quality Resources
Menorah Medical Center
5721 W. 119th Street | Overland Park, Kansas 66209
Charlene.Thiry@hcahealthcare.com
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The physician's here definitely consider Accelerated HTN and Malignant HTN two different things. Here are the definitions we placed on our query.
"Accelerated Hypertension" requires urgent treatment and meets one of the following criteria:
Yesterday I used Dr. Pinson's info from his text "2011 CDI Pocket Guide" pgs 16-17 to write a query using his examples on pg 17 looking for "hypertensive urgency due to accelerated hypertension". Hypertensive urgency and hypertensive emergency were all that was documented. BP up to 241/137 and in that range for over an hour. Required IV labetalol and ongoing scheduled doses and PO nifedipine. I especially like Dr. Pinson's comment "examples of how physician documentation may incorporate current clinical terminology with that needed to support correct coding". The physicians like to write hypertensive urgency, emergency, crisis, etc but these current terms can't be coded.
I am happy to say the physician responded with documentation that included accelerated hypertension, adding severity to the otherwise 401.9 unspecified hypertension code.
Karen Maritano, R. N.
Clinical Documentation Specialist
Legacy Health
Portland, Oregon
503-413-7154
Karen Maritano, R. N.
Clinical Documentation Specialist
Legacy Health
Portland, Oregon
503-413-7154