Remember 3 Dx Codes for This CKD/Hypertension Patient
Question: The emergency department (ED) provider performs an evaluation and management (E/M) service for a patient who presents for treatment of stage 1 hypertensive chronic kidney disease (CKD). The patient’s past medical history indicates that they have primary hypertension that they are taking medication for, but it wasn’t the main issue for the patient, who has been taking their hypertension medication on time. How many diagnosis codes would I need for this patient? RCI Subscriber Answer: You’ll need three diagnosis codes to report this claim correctly, and the order matters. First, you’ll code I12.9 (Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease) for the CKD. There’s a note below this entry instructing you to “Use additional code to identify the stage of chronic kidney disease.” This directs you to N18.1 (Chronic kidney disease, stage 1), which you’ll list second on the claim. These are the diagnosis codes for the problems the ED physician treated in the patient upon presentation, so they need to go first. Then, you’ll report I10 (Essential (primary) hypertension) to represent the patient’s hypertension. Make sure you append these ICD-10-CM codes — in this order — to your ED E/M service code (CPT® 99281-99285). Chris Boucher, MS, CPC, Senior Development Editor, AAPC
