I67.4

Billable

Hypertensive encephalopathy

HCC Category Mapping

RxHCCHCC 187 — Hypertension

0.000

What This Code Means

A serious brain condition caused by severely elevated blood pressure that leads to swelling and dysfunction of the brain. This is a medical emergency requiring immediate treatment to lower blood pressure and prevent permanent brain damage.

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)

Excludes 2 — Not included here, may code separately

insufficiency, NOS, of precerebral arteries (G45.2)

Code Also

, if applicable, associated hypertensive conditions such as:
essential (primary) hypertension (I10)
hypertensive chronic kidney disease (I12.-)
hypertensive heart and chronic kidney disease (I13.-)
hypertensive heart disease (I11.-)

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

Code Hierarchy

└I67Other cerebrovascular diseases └I67.4Hypertensive encephalopathy

└I67.4Hypertensive encephalopathy