I67.4 ICD-10-CM Code: Hypertensive encephalopathy

Code

I67.4

Description

Hypertensive encephalopathy

HCC (V28)

No CMS-HCC V28 mapping

RAF reference coefficient

—

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work I67.4 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for I67.4

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I67.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Hypertensive encephalopathy requires documentation of both the hypertension and the encephalopathy; verify the provider has documented the causal relationship between elevated blood pressure and brain symptoms
• •This code should be used only when encephalopathy is present as a direct result of hypertensive crisis; do not use for hypertension alone or for encephalopathy from other causes

Clinical Significance

Hypertensive encephalopathy is a medical emergency resulting from severely elevated blood pressure causing cerebral edema and neurological dysfunction. It manifests with headache, altered mental status, visual disturbances, and seizures, and can progress to coma if untreated. While this is a critical acute condition, it does not currently map to an HCC in either V24 or V28 risk adjustment models.

Documentation Requirements

• ✓Provider documentation explicitly stating hypertensive encephalopathy as the diagnosis
• ✓Documentation of severely elevated blood pressure readings at presentation
• ✓Neurological symptoms and signs (headache, altered consciousness, seizures, visual changes)
• ✓Imaging when available (CT/MRI may show posterior reversible encephalopathy syndrome or cerebral edema)
• ✓Response to blood pressure lowering treatment supporting the diagnosis
• ✓Exclusion of other causes of encephalopathy (metabolic, infectious, toxic)

Commonly Confused Codes

• •I16.1: Hypertensive emergency; captures the severe blood pressure elevation but not specifically the encephalopathy
• •G93.49: Other encephalopathy; for non-hypertensive causes
• •I67.3: Progressive vascular leukoencephalopathy; a chronic condition unlike the acute nature of hypertensive encephalopathy
• •I67.89: Other cerebrovascular disease; less specific

Child Codes