Patient presents with hypertensive emergency, defined as severely elevated blood pressure (BP) greater than or equal to 180/120 mmHg with evidence of acute target organ damage.  Presenting symptoms include severe headache, blurred vision, dizziness, and shortness of breath.  Patient also reports chest pain and nausea.  Physical examination reveals elevated heart rate, papilledema on funduscopic exam, and pulmonary crackles suggestive of acute pulmonary edema.  Initial blood pressure reading was 210/130 mmHg.  Electrocardiogram (ECG) shows left ventricular hypertrophy.  Laboratory tests including complete blood count (CBC), basic metabolic panel (BMP), cardiac enzymes, and urinalysis are ordered to assess for end-organ damage and guide treatment.  Differential diagnoses include hypertensive urgency, pheochromocytoma, and renal artery stenosis.  The patient's hypertensive crisis is attributed to non-compliance with prescribed antihypertensive medications.  Intravenous (IV) antihypertensive therapy with labetalol is initiated with a goal of gradually lowering blood pressure to avoid cerebral hypoperfusion.  Patient is admitted to the intensive care unit (ICU) for continuous blood pressure monitoring and further management.  Diagnosis codes for this encounter include I16.0 malignant essential hypertension, I10 essential (primary) hypertension, and I67.9 unspecified cerebrovascular disease.  Billing codes may include 99291 for critical care services, as well as codes for laboratory and imaging studies.  The patient's condition will be closely monitored, and adjustments to the treatment plan will be made as needed.