Wiki Anemia in CKD

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JenLawson

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Hi All,
I am trying to find documentation that determines what the requirment is for support of dx code 285.21. I am finding indications that a correlation between the anemia and the CKD must be established by the doctor in order for the use of this code to be supported.
Doctors are telling me that there is no way to make a definitive correlation that indicates the CKD is causing the anemia. I would like to have something concrete to take to them and show that the documentation is required and what form that documentation should take. Currently their documentation either doesn't indicate that CKD caused the anemia at all, or they say it is likely, or possibly caused by CKD.
Anything anyone can share that shows in writing what is expected would be helpful.
Thank you
Jennifer
 
Anemia secondary to CKD

In a patient who is EPO-resistent (has a deficient level of erythroprotein in the blood,) this can be caused by CKD as well as heart disease. If the provider is not providing a direct correlation or is stating "possibly'' due to CKD, you can only code Anemia unspecified, 285.9. If the provider specifically states "anemia due to or secondary to the CKD," you can code it as such, with the 285.21. Bottom line: Even if the provider stated the patient was EPO-resistent or something to that effect, unless they directly correlate and state such you cannot code the 285.21, Anemia secondary to chronic kidney disease. Also, if a diagnosis is stated as "possible" or "rule out", it should not be coded. I would query the physician/provider. The way I was taught was "Don't code it if it was not stated." Hope that helps.
 
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Can you give me a source that gives that guideline though? I keep finding that same information in various places but I never see a source where CMS or some other authority states that this is the case. There isn't even anything regarding that in the ICD-9 guidelines.
This is the reason I ask the question. If a definitive correlation cannot be made by the doctors from the tests how can there be a requirement that the doctor state a correlation in their documentation?
I know with things like hypertension and heart disease or hypertension and CKD a stated relationship is or is not required. However, I cannot find any source material anywhere that states this is the case with anemia and CKD.
Thanks
 
I also posted this to LinkedIn and it was pointed out there that it does state in the IDC-9-CM guidelines, "When assigning code 285.21, Anemia in chronic kidney disease, it is also necessary to assign a code form category 585, Chronic kidney diseas, to indicate the stage of chronic kidney disease."

My thought here is that if they have used both of those codes in the assessment, can I conclude that this is the correct anemia code due to the fact that they have also listed CKD in the assessment? Or as stated above is it absolutely necessary that the relationship be stated in the documentation?

What are your thoughts?

Jennifer
 
I have found the following information:

One of the challenges with CKD coding is the relationship to other conditions. For example, anemia in CKD is assigned codes 285.21 and 585.x. The sequencing of the codes is dependent upon the reason for the encounter or admission. In order to assign these codes the provider must document the cause-and-effect relationship between CKD and anemia.

It is available at:
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_034247.hcsp?dDocName=bok1_034247

I wanted to share in case someone else had the same question at some point.

Another thing to point out is in the ICD-9-CM tabular:

285.2 Anemia of chronic disease
Anemia in (due to) (with) chronic illness

The implication here is that 'in' is equivalent to 'due to' or 'with' in this case. It is indirect but does support the need to have the relationship stated in the documentation in order to use the code 285.21 Anemia in chronic kidney disease.

Jennifer
 
As per icd 10 coding guidelines any two conditions are linked with "IN or IN DUE TO or WITH" you can assume cause and effect relationship between both conditions and code combination code.

15. “With”
The word “with” or “in” should be interpreted to mean “associated with” or “due to”
when it appears in a code title, the Alphabetic Index (either under a main term or
subterm), or an instructional note in the Tabular List. The classification presumes a
causal relationship between the two conditions linked by these terms in the Alphabetic
Index or Tabular List. These conditions should be coded as related even in the absence
of provider documentation explicitly linking them, unless the documentation clearly
states the conditions are unrelated or when another guideline exists that specifically
requires a documented linkage between two conditions (e.g., sepsis guideline for “acute
organ dysfunction that is not clearly associated with the sepsis”).
For conditions not specifically linked by these relational terms in the classification or
when a guideline requires that a linkage between two conditions be explicitly
documented, provider documentation must link the conditions in order to code them as
related.
The word “with” in the Alphabetic Index is sequenced immediately following the main
term or sub term, not in alphabetical order.
 
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