Wiki NEW CKD 3 codes

mnuhfer04

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I'm trying to better understand what the difference is between the new codes N18.31 and N18.32 (stage 3a and 3b). I have looked in the new 2021 book and the guidelines, but I can't find anything. Maybe I'm missing something. Would someone be able to explain this to me? Thanks!
 
Patients fall into stage 3a or 3b CKD depending on their estimated glomerular filtration rate (eGFR) lab results. Since this requires an interpretation by the physician of the kidney function tests, it's not something a coder needs to know in order to assign the code since we can only use what a provider has documented. I've found that in the practices I work with, almost all physicians will just document 'stage 3', which of course would just be coded as N18.30, stage 3 unspecified.
 
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Patients fall into stage 3a or 3b CKD depending on their estimated glomerular filtration rate (eGFR) lab results. Since this requires an interpretation by the physician of the kidney function tests, it's not something a coder needs to know in order to assign the code since we can only use what a provider has documented. I've found that in the practices I work with, almost all physicians will just document 'stage 3', which of course would just be coded as N18.30, stage 3 unspecified.
Thank you! Same with our physicians.
 
Unfortunately, N18.30, N18.1 and N18.2 are no longer considered medically necessary codes for most of the ESA products these dx are utilized for. With ALOT of gentle reminders and continued education, we are finally able to get the providers to code this to the highest level of specificity (N18.3a or N18.3b) which is what payers want.
 
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