Learn How to Code Diabetic CKD and Hypertensive CKD
Question: I have a medical record with type 2 diabetes mellitus, hypertension, and stage 3a chronic kidney disease (CKD) listed as diagnoses. How should we report the codes? Ohio Subscriber Answer: You’ll need three ICD-10-CM codes to report the conditions you’ve mentioned. Assign I12.9 (Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease) to report the hypertension and CKD. Use E11.22 (Type 2 diabetes mellitus with diabetic chronic kidney disease) to report the type 2 diabetes mellitus with CKD. This code also features a Use additional code note directing you to include a code that identifies the CKD stage, which the physician listed as stage 3a in the documentation. Assign N18.31 (Chronic kidney disease, stage 3a) to report the stage 3a CKD diagnosis. Parent code N18.- (Chronic kidney disease) has a Code first note that instructs you to use a diabetic CKD or hypertensive CKD code first if the conditions are associated with the CKD. In your case, the physician documented both diabetic CKD and hypertensive CKD, so how should you sequence the codes? Use E11.22 as the first code, followed by I12.9 and, lastly, N18.9. According to the AHA Coding Clinic® for ICD-10-CM/PCS, Volume 5, Issue 4, “The classification presumes a cause-and-effect relationship between both diabetes and CKD and hypertension and CKD. CKD is most likely related to both hypertension and diabetes when the patient has all three conditions. Both high blood sugar and high pressure in the blood vessels will cause the vessels to deteriorate, which can then damage the kidneys.” Mike Shaughnessy, BA, CPC, Production Editor, AAPC
