Oncology & Hematology Coding Alert

Question: I know that coding guidelines tell you that a chronic kidney disease (CKD) code should be a primary diagnosis, but if we are treating a patient in our hematology/oncology practice for anemia due to CKD, does the anemia code take precedence, which is what one of our payers wants?

AAPC Forum Participant

Answer: Sequencing of ICD-10-CM codes involving conditions related to CKD are subject to guidelines established in the Tabular List for the particular condition (see guideline C.14.a.3, which tells you that “the sequencing of the CKD code in relationship to codes for other contributing conditions is based on the conventions in the Tabular List”).

So, per the “code first” instructional note that accompanies D63.1 (Anemia in chronic kidney disease), you will code first the appropriate CKD code from N18.- (Chronic kidney disease), adding the appropriate 4th digit to document the stage of the disease.

Whether or not your payer follows ICD-10-CM guidelines is another matter entirely. They may choose to deny based on official ICD-10-CM sequencing, so it is best to check payer policies to see which primary diagnosis code they will accept in this situation.