Coding for CKD Under the ICD-10-CM Code Set

Comments
Print

By Betty Johnson, CPC, CPC-I, CPC-H, CPCD, CCS-P, PCS, CCP, CIC, RMC

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 included provisions for standardization of healthcare information, which opened the path to ICD-10-CM in the United States.  The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) was developed by the U.S. National Center for Health Statistics (NCHS) along with an advisory panel to ensure accuracy and utility in 1993.  On January 5, 2009, the U.S. Department of Health and Human Services (DHHS) announced that ICD-9-CM would be replaced by the ICD-10 system (ICD-10-CM and ICD-10-PCS) on October 1, 2013.  All HIPAA covered entities must comply with this date.  ICD-10-CM codes are all alphanumeric, starting with an alpha character, as opposed to V and E codes in ICD-9-CM.  This article will discuss the guidelines and diagnosis codes related to dialysis patients.

According to the National Kidney Foundation, 26 million American adults have CKD.  Dialysis is most commonly prescribed in adult patients for temporary or permanent kidney failure.  Diabetes and hypertension are responsible for CKD in up to 2/3 of the cases.  We will address the ICD-10-CM codes and guidelines for diabetic chronic kidney disease and hypertensive chronic kidney disease.

Diabetes with Diabetic Chronic Kidney Disease

In ICD-10-CM, more than one code is required to diagnose diabetic chronic kidney disease: one combination code that indicates the type of diabetes with chronic kidney disease and one that indicates the stage of CKD.  The diabetes codes in ICD-10-CM are found in Chapter 4, Endocrine, Nutritional, and Metabolic Diseases (E00-E89).  There are five (5) categories for diabetes codes in ICD-10-CM, compared to one in ICD-9-CM.  This is due to the fact that the diabetes mellitus codes in ICD-10-CM are combination codes.  The codes include the type of diabetes mellitus, the body system affected, and the complications affecting that body system.  There five categories are as follows:

  • E08 Diabetes mellitus due to an underlying condition
  • E09 Drug or chemical induced diabetes mellitus
  • E10 Type 1 diabetes mellitus 
  • E11 Type 2 diabetes mellitus
  • E13 Other specified diabetes mellitus

The following codes indicate CKD in diabetic patients in ICD-10-CM:

  • E08.22 Diabetes mellitus due to underlying condition with diabetic chronic kidney disease
  • E09.22 Drug or chemic induced diabetes mellitus with diabetic chronic kidney disease
  • E10.22 Type I diabetes mellitus with diabetic chronic kidney disease
  • E11.22 Type II diabetes mellitus with diabetic chronic kidney disease
  • E13.22  Other specified diabetes mellitus with diabetic chronic kidney disease

Only one code from above would be chosen, based on the type of diabetes. 

Under each of the codes listed above, there is a note that directs the user to “Use additional code to identify stage of chronic kidney disease.”  This indicates that a second code would need to be listed after the diabetes code.  This code will be used to specify the stage of CKD of the patient.

The codes for chronic kidney disease are found in Chapter 14, Diseases of the Genitourinary System (N00-N99).  ICD-10-CM classifies CKD based on severity.  The following codes indicate CKD in ICD-10-CM:

  • N18.1   Chronic kidney disease, stage 1
  • N18.2   Chronic kidney disease, stage 2 (mild)
  • N18.3   Chronic kidney disease, stage 3 (moderate)
  • N18.4   Chronic kidney disease, stage 4 (severe)
  • N18.5   Chronic kidney disease, stage 5
  • N18.6   End stage renal disease
  • N18.9   Chronic kidney disease, unspecified

Under the subcategory of N18, Chronic kidney disease (CKD), there is a note that directs the user to “Code first any associated diabetic chronic kidney disease (E08.22, E09.22, E10.22, E11.22, E13.22)”.  This is to remind the user to code the diabetes as the first-listed code, as discussed above.

Example: Type I diabetes mellitus with diabetic end stage renal disease.  The proper ICD-10-CM codes, in order, for this patient would be:

  • E10.22   Type I diabetes mellitus with diabetic chronic kidney disease
  • N18.6   End stage renal disease

Hypertensive Chronic Kidney Disease

In ICD-10-CM, more than one code is required to diagnose hypertensive chronic kidney disease: one combination code that indicates the patient has both hypertension and CKD, and one that indicates the stage of CKD.  The hypertension codes are found in Chapter 9, Diseases of Circulatory System (I00-I99). 

According to the ICD-10-CM Draft Official Guidelines for Coding and Reporting 2011 (C.9.a.2), assign codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present.  Unlike hypertension with heart disease, ICD-10-CM presumes a cause-and-effect relationship and classifies chronic kidney disease with hypertension as hypertensive chronic kidney disease.  The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease.  If the patient has hypertensive chronic kidney disease and acute renal failure, an additional code for the acute renal failure is required.

« Previous12Next »
Comments
comments powered by Disqus