Wiki ESRD & Diabetes

[burnam.megan@gmail.com]

I am coding for a dialysis facility, therefore all of my patients have ESRD (N18.6). The majority of my patients also have diabetes, but it is either not documented as to whether diabetes caused the ESRD or the record will state the ESRD was caused by another disorder, but the patient also has DM.

My question is: If diabetes is not listed as the cause of ESRD or there is another cause for the ESRD, do I still code E10.22 or E11.22 for the diabetes?

Others have advised when DM is not listed as the cause of ESRD, to code E10.21 / E11.21 or E10.29 / E11.29. I am having a hard time understanding this since one is for diabetic nephropathy and other diabetic kidney complications.

I am wondering if coding for diabetes & ERSD is similar to coding HTN & ESRD, whereas the relationship is assumed.

Would someone please advise?

Thank you!!

 

[erjones147]

the relationship between DM and ESRD is NOT assumed. Code separately unless you have definitive documentation indicating otherwise

If the relationship is established, then use the .22 codes. I have no idea why someone would advise you to use the .21 or .29 codes

 

[mitchellde]

The physician must always document the relation between a condition and the diabetes. You would not use the .22, .21, or the .29 without specific documentation. With no documented relationship you would code the N18.6 and E11.9 or E10.9.

 

[klenroberts]

I'm not sure if this applies but there is a new coding clinic (3/18/16) regarding DM and ESRD (First Quarter 2016, Pages 12-13). This coding clinic discusses DM with a Foot Ulcer but it does state that ICD-10-CM assumes a casual relationship between DM and the foot ulcer, as well as the CKD. The answer uses code E11.22 and N18.6. I hope this helps with your question.

 

[mitchellde]

I have requested additional information from coding clinics in regards to this issue. I will let you know when or if they respond