malignant/accelerated HTN

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Talk Archive
We are having a hard time getting Drs to document malignant or accelerated HTN. They say these are "old terms" and prefer hypertensive urgency, emergency, and crisis.
I have made a standard query to ask for specificity when these terms are used that gives the options for hypertension according to coding (essential, benign, accelerated, malignant). Now they want definitions including on the query. However, I am seeing that they are right and organizations like the AHA are using the terms urgency/crisis as well.
Anyone have a good reference?

Thanks,
Katy

Comments

  • catladyrncatladyrn
    Malignant/accelerated HTN and hypertensive urgency are not the same thing.

    http://medicine.ucsf.edu/education/resed/Chiefs_cover_sheets/april11_hypertensive_emerg1.pdf

    If you think it's malignant and they don't believe you, tell them that it won't code out the same, because it won't.

    It's a lot like the ACS game, where we know clinically that ACS might mean NSTEMI, but without the documentation, it codes out to unstable angina, so we have to get specificity that satisfies the coding conventions.

    Renee


    Linda Renee Brown, RN, CCRN, CCDS
    Certified Clinical Documentation Specialist
    Banner Good Samaritan Medical Center
  • katysuegood@gmail.comkatysuegood@gmail.com
    Right. I know they are not the same thing. But, those are the only terms they are using, even when "malignant" hypertension would be appropriate. They dont think we should be using malignant at all.

    From what I have read, (I'm certainly not the expert) malignant and accelerated HTN are both types of hypertensive emergencies. However, they use the term emergency not accelerated or malignant. They also seam to use the terms urgency/crisis and emergency somewhat interchangeably.

    I just found some decest definitions/descriptions here.

    http://emedicine.medscape.com/article/241640-overview


    I'm just not sure if they will be happy with a Medscape reference!


    Thanks!

    Katy
  • catladyrncatladyrn
    Urgency/crisis/emergency will all code out to HTN. Accelerated/malignant will code out to malignant HTN, a CC.

    All accelerated/malignant HTN cases are emergencies.
    Not all emergency HTN cases are accelerated/malignant.

    So while the docs know what's going on clinically, you need to teach them how it will code out. If there are clinical signs of malignant HTN, then you should query, if necessary with an explanation of why you're asking.

    Renee


    Linda Renee Brown, RN, CCRN, CCDS
    Certified Clinical Documentation Specialist
    Banner Good Samaritan Medical Center
  • sbeattysbeatty
    The CDS Pocket Guide has a nice explanation of the issue that we provided to our hospitalists. They have been changing the diagnosis back and forth based on their individual opinions that accelerated HTN is not a diagnosis or it is. We pointed out that we would query every time the clinical findings and treatment plan indicated a condition of higher severity than HTN NOS. We also made the point that coming to a census among themselves would decrease the number of concurrent and retro-queries they receive due to the discrepancies in the medical record. They have agreed among themselves to come up with a phrase that meets their clinical standards and our coding standards. Recently I've seen hypertensive emergency due to accelerated HTN used when the clinical presentation indicates a higher level of severity/risk and treatment. Hope that helps.
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