hypertension emergency

Flo301@aol.comFlo301@aol.com
in Clinical & Coding
Does a pt. that is noncompliant with blood pressure medication and presents to ED with fluid overload, acute on chronic diastolic HF and SBP of 230 given IV antihyperstesive (labetalol and hydralazine) code as hypertensive emergency or urgency?

Comments

  • 2083184620831846
    If a patient has HTN and has documentation in the MR HTN and has CHF  you can use the code for Hypertensive Heart as your PDX and take the mcc of A/C Diastolic HF.   If HTN emergency or urgency has not been documented by the attending you will need to query. 
  • Flo301@aol.comFlo301@aol.com
    CHF and HTN was documented along with hypertensive urgency.  Question is should hypertensive emergency qualify for a person coming in with SBP of 230 and receiving IV antihypertensive meds due to noncompliance?
  • kwilliams@halifaxrmc.orgkwilliams@halifaxrmc.org

    The medical situation would be the same whether compliant or not. Noncompliance would be coded.

  • stampinsavage@gmail.comstampinsavage@gmail.com
    I was under the impression that hypertensive emergency was defined, based on the presence of symptomology as well as the elevated blood pressure reading. There has to be documentation of headache, visual disturbance, numbness/tingling, etc as well as treatment with IV anti hypertensive medications.
  • matthewayinde@hirecdi.commatthewayinde@hirecdi.com
    Clinical information about hypertensive emergency-

    Clinical definition: 

    ·        Systolic blood pressure (BP) > 220 mm Hg, or

    ·        Diastolic BP > 120 mm Hg, or

    ·        End-organ involvement/damage (e.g., neurologic, renal, or cardiac damage)

     End organ damage by Systems –

    •                  Assess patient eyes for Papilledma

    •                  CNS - Altered mental status or ICH

    •                  Kidney - Renal Failure

    •                  Lung - Pulmonary Edema

    •                  Heart - CHF, MI, USA, Aortic Dissection

     

    Treatment

    1.       This condition is treated in the ICU.

     

    2.       Short-acting IV drug: nitrates, fenoldopam, nicardipine, or labetalol

     

    3.       Goal: 20 to 25% reduction MAP in 1 to 2 h

  • donnaparton@cox.netdonnaparton@cox.net
    matthewayinde@hirecdi.com said:
    Clinical information about hypertensive emergency-

    Clinical definition: 

    ·        Systolic blood pressure (BP) > 220 mm Hg, or

    ·        Diastolic BP > 120 mm Hg, or

    ·        End-organ involvement/damage (e.g., neurologic, renal, or cardiac damage)

     End organ damage by Systems –

    •                  Assess patient eyes for Papilledma

    •                  CNS - Altered mental status or ICH

    •                  Kidney - Renal Failure

    •                  Lung - Pulmonary Edema

    •                  Heart - CHF, MI, USA, Aortic Dissection

     

    Treatment

    1.       This condition is treated in the ICU.

     

    2.       Short-acting IV drug: nitrates, fenoldopam, nicardipine, or labetalol

     

    3.       Goal: 20 to 25% reduction MAP in 1 to 2 h


  • donnaparton@cox.netdonnaparton@cox.net

    Matthew,

         Can you give your source(s)?
                      Thank you


  • matthewayinde@hirecdi.commatthewayinde@hirecdi.com
    Sure Donna...

    Please see attached images from the book- Step up to Medicine.

    You purchase a copy - https://shop.lww.com/Step-Up-to-Medicine/p/9781496306142

    I am an avid reader of Step up to medicine. I will encourage any CDI specialist trying to improve clinical skills to get a copy in addition to some Medcram videos, Merck manual, and uptodate contents. These are usually my go to clinical resources.

    Thank you 
  • matthewayinde@hirecdi.commatthewayinde@hirecdi.com

  • matthewayinde@hirecdi.commatthewayinde@hirecdi.com

    I will also recommend reading the article below. Look at Table 1: See definitions of hypertensive urgency/emergency and guided directed treatments.  Further, into the article the Dr. Marhefka discussed what constituent target organ damage. 

    ACUTE HYPERTENSION: HYPERTENSIVE URGENCY AND HYPERTENSIVE EMERGENCY

    By: Gregary D. Marhefka, MD

    https://www.consultant360.com/articles/acute-hypertension-hypertensive-urgency-and-hypertensive-emergency

     

  • rrdouglasrrdouglas
    The definitions of hypertensive crisis, urgency, and emergency were also discussed on the recent ACDIS radio.  https://acdis.org/acdis-radio/acdis-mailbag-listener-questions
  • donnaparton@cox.netdonnaparton@cox.net
    Sorry just got back to this. Thank you so much!!!!
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