Accelerated hypertension

Why is an archaic term like “accelerated” necessary for the correct documentation and coding of severe hypertension? Unfortunately, coding terminology hasn't caught up with the currently accepted clinical diagnostic terms for severe, uncontrolled hypertension.

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Terms such as “hypertensive emergency,” “hypertensive crisis,” “hypertensive urgency,” “severe hypertension,” “malignant hypertension” and “accelerated hypertension” are all used in the literature and often overlap. Yet “accelerated” and “malignant” hypertension are the only terms that will code to a serious, severe or problematic hypertensive condition. The terms “hypertensive urgency,” “hypertensive emergency” or “hypertensive crisis” alone will be classified to a non-specific or benign hypertension code having virtually no clinical significance.

A patient with hypertension that is defined as “accelerated” or “malignant” should require urgent treatment (either IV or STAT oral dosing); have the same risks and clinical implications as urgent or emergent hypertension; and meet one of the following criteria:

  • systolic blood pressure (BP) >180 mm Hg, or
  • diastolic BP >110 mm Hg, or
  • symptoms attributable to the hypertension (e.g., headache, dyspnea or chest pain), or
  • end-organ involvement/damage (e.g., neurologic, renal or cardiac damage).

How do these criteria for accelerated hypertension compare with more current terminology?

  • “Hypertensive urgency” is defined as having blood pressure >180/110 mm Hg, with or without symptoms like severe headache, shortness of breath and anxiety, and no end-organ involvement.
  • “Hypertensive emergency” is usually symptomatic with blood pressure >180/120 mm Hg, and end-organ involvement. Possible symptoms include chest pain and neurologic deficits.
  • “Hypertensive crisis” is used to describe the spectrum of severe, uncontrolled hypertension that includes both urgent and emergent hypertension, as described above.

Examples of documentation that combines current clinical terms with what's needed for correct coding are “accelerated hypertension with hypertensive emergency” and “hypertensive urgency due to accelerated hypertension.”