Home Health ICD-9/ICD-10 Alert
403.xx: Base Fifth Digit for Hypertensive Kidney Disease on Stage
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Question: How should we code for a patient with renal sclerosis due to hypertension? Massachusetts subscriber Answer: Not only does ICD-9-CM assume a relationship between hypertension and kidney disease, but this patient's documented diagnosis also indicates the link, so you'll code for this patient with a 403.xx (Hypertensive chronic kidney disease) code. New instruction from the American Hospital Association's Coding Clinic for ICD-9, Fourth Quarter 2010 offers clarification on how to select a fifth digit for this patient. You'll assign 403.90 (Hypertensive chronic kidney disease; unspecified; with chronic kidney disease stage I through stage IV, or unspecified). "0" is the appropriate fifth digit because "there is no chronic kidney disease stage specified." Remember to also list 587 (Renal sclerosis, unspecified). In a related question, Coding Clinic addresses how to report a patient with renal sclerosis due to hypertension and stage V chronic kidney disease. For this patient, you would list 403.91 (Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease), 587, and 585.5 (Chronic kidney disease, stage V). Choose the fifth digit for subcategory 403.9x based on the patient's CKD stage, in this case 403.91.
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