Wiki DM Nephropathy with CKD and HTN

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Code: E11.22

Code Name: ICD-10 Code for Type 2 diabetes mellitus with diabetic chronic kidney disease

Block: Diabetes mellitus (E08-E13)

Details: Type 2 diabetes mellitus with diabetic chronic kidney disease

Use additional code to identify stage of chronic kidney disease (N18.1-N18.6)
E11
Use additional code to identify control using:insulin (Z79.4)
oral antidiabetic drugs (Z79.84)
oral hypoglycemic drugs (Z79.84)

Includes: diabetes (mellitus) due to insulin secretory defect
diabetes NOS
insulin resistant diabetes (mellitus)

Excludes1: diabetes mellitus due to underlying condition (E08.-)
drug or chemical induced diabetes mellitus (E09.-)
gestational diabetes (O24.4-)
neonatal diabetes mellitus (P70.2)
postpancreatectomy diabetes mellitus (E13.-)
postprocedural diabetes mellitus (E13.-)
secondary diabetes mellitus NEC (E13.-)
type 1 diabetes mellitus (E10.-)

Guidelines: Endocrine, nutritional and metabolic diseases (E00-E89)

Excludes 1: transitory endocrine and metabolic disorders specific to newborn (P70-P74)

Note: All neoplasms, whether functionally active or not, are classified in Chapter 2. Appropriate codes in this chapter (i.e. E05.8, E07.0, E16-E31, E34.-) may be used as additional codes to indicate either functional activity by neoplasms and ectopic endocrine tissue or hyperfunction and hypofunction of endocrine glands associated with neoplasms and other conditions classified elsewhere.

For more details on E11.22, ICD-10 Code for Type 2 diabetes mellitus with diabetic chronic kidney disease , visit: https://coder.aapc.com/icd-10-codes/

tharal

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Hi,

Coding clarification needed.

Here is the scenario...

Patient has Diabetic Nephropathy, CKD 3 and HTN. What all diagnosis codes we need to assign?

Thanks in advance for any help!

Thara L CPC H
 

mitchellde

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Befor I offer up an answer, it would be beneficial for you to look in the coding guidelines, then look at the codes in the code book. This is very straight forward and the answer is there. Then come back to this thread and post your answer if you desire confirmation.
 

tharal

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hi,

Code book will direct to 250.4x and 583.81, 403.9x and 585.x codes, and I need to confirmation about 583.81, do we need to code 583.81 with Chronic kidney disease. 585.x series codes.

Thanks
Thara L CPC H
 

tharal

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Hi,

Someone in our facility is instructed use 250.40, 583.81, 403.90 and 585.x for the scenario. But when seeing the following coding clinic I came to the conclusion that we dont need to add 583.81 for the scenario. see the coding clinic below.

Renal failure due to diabetic nephropathy in patient w/hypertension
Coding Clinic, First Quarter 2003 Page: 20 to 21
Effective with discharges: April 30, 2003

Question:

What is the appropriate coding of chronic renal failure (CRF) due to diabetic nephropathy when the patient also has a diagnosis of hypertension?

Answer:

Assign code 250.40, Diabetes with renal manifestations, type II [non-insulin dependent type] [NIDDM type] [adult-onset type] or unspecified type, not stated as uncontrolled, and code 403.91, Hypertensive renal disease, with renal failure, for diabetic nephropathy with chronic renal failure and hypertension. Diabetes mellitus is one of several disease categories in ICD-9-CM where one code classifies both the disease and its manifestations. Additional codes may be assigned to further describe the manifestations. The following diagnoses: diabetic renal failure, diabetic uremia, diabetic intercapillary glomerulosclerosis and chronic renal failure, diabetic nephropathy with chronic renal failure, or diabetic nephrosis with chronic renal failure provide a cause-and-effect relationship, requiring that code 250.4X, Diabetes with renal manifestations, be sequenced first.

ICD-9-CM assumes a cause-and-effect relationship and classifies chronic renal failure with hypertension as hypertensive renal disease. At category 403, the note reads "any condition classifiable to 585, 586, 587 with any condition classifiable to 401." This wording indicates that the linkage is so compelling when both conditions are present (hypertension and chronic or unspecified renal failure) that hypertensive renal disease is coded. Therefore, if the physician has not indicated "CRF not due to hypertension," code 403.91, Hypertensive renal disease, unspecified, with renal failure, would be assigned.


Thara L CPC H
 

mitchellde

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The coding clinic does not state to not code the 585.- code it is clarifying that you do use the the 250.40 and the 403.91 together. The code categories 403 and 250.6 specify to add the additional codes therefore you do need the nephropathy and the CKD codes.
 

jbrightw

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The correct coding for this scenario is 250.4x, 583.81, 403.90 and 585.3

Please refer this coding clinic too


Coding Clinic, September - October 1984 Page: 3 to 4


Diabetes Mellitus



Diabetes mellitus (250) is one of a number of disease categories in ICD-9-CM in which the basic disease category serves as the primary code to classify both the disease and its major manifestations. Additional codes may be used as secondary codes to provide more specificity in describing the manifestations. The diagnoses of diabetic renal failure, diabetic uremia, diabetic intercapillary glomerulosclerosis and chronic renal failure, diabetic nephropathy with chronic renal failure, or diabetic nephrosis with chronic renal failure provide a cause-and-effect relationship, thus requiring that code 250.4 (with fifth digit) be listed as the primary code, followed by 581.81 as the secondary code. Code 585, chronic renal failure, may be used as an additional code where desirable.

Jesus Brightwin
 

jbrightw

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How come 403.90 can be coded at last without additional code and what is the change you have mentioned?

Jesus Brightwin
 
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ICD9 Guidelines

Diabetic Nephropathy

250.40, 583.81

ICD9 Guidelines:

?For each code under category 250 there is a use additional code note for the manifestation that is specific for that particular diabetic manifestation. Should a patient have more than one manifestation of diabetes, more than one code from category 250 may be used with as many manifestation codes as are needed to fully describe the patient?s complete diabetic condition. The category 250 diabetes codes should be sequenced first, followed by the manifestation codes.?

Chronic Kidney Disease, Stage 3, Hypertension

403.90, 585.3

ICD9 Guidelines:

Hypertensive Chronic Kidney Disease

?Assign codes from category 403, Hypertensive chronic kidney disease, when conditions classified to category 585 or code 587 are present with hypertension. Unlike hypertension with heart disease, ICD-9-CM presumes a cause-and-effect relationship and classifies chronic kidney disease (CKD) with hypertension as hypertensive chronic kidney disease.

Fifth digits for category 403 should be assigned as follows:
? 0 with CKD stage I through stage IV, or unspecified.
? 1 with CKD stage V or end stage renal disease.
ICD-9-CM Official Guidelines for Coding and Reporting Effective October 1, 2011 Page 37 of 107

The appropriate code from category 585, chronic kidney disease should be used as a secondary code with a code from category 403 to identify the stage of chronic kidney disease.?
See section I.C. 10.a
 

amberlarsen820

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The answer is in multiple places in the code book: the guidelines and the tabular.

When you look up "diabetic nephropathy" in the index the code listed is 250.4 (583.81). The 250.4 needs an extra digit. When you go to 250.4 in the tabular, it tells you what fifth digit to assign in the box. Also, after 250.4, it says "use addition code to identify manifestation" which in this case, it would be nephropathy (583.81). When you look up 583.81 in the tabular, it directs you to "code first underlying disease" (which is diabetes with renal manifestations.)

For CKD, ICD-9 assumes a relationship between Hypertension and CKD. If you look at 585 category in the tabular, it says "code first, hypertensive CKD if applicable" and directs you to 403.00-403.91.

(Can you tell I work for a nephrology clinic?)

Remember, you have to code from the index, tabular, and check your guidelines when assigning codes! :)
 
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