Wiki Understanding sequencing diagnosis codes with causal relationships

[lindsayrowell]

Hi,

I'm not a new coder, but I have really been studying the guidelines to ensure that I have a good understanding on code sequencing. I thought it might be a good idea to get a refresher on some common scenarios I see at work. I might be overthinking this so I'm really just looking for some opinions from my fellow coders on how you handle these codes. I'm going to give a made-up scenario that includes DM2, CKD, and HTN to see which diagnosis codes you would choose. For the specific scenario, the provider did not give any kind of indication in the note that the CKD and HTN were unrelated.

Assessment and Plan

1. Controlled Type 2 DM with hypoglycemia w/o coma - E11.649
[insert plan]

2. T2DM with diabetic CKD - E11.22
[insert plan]

3. Hyperlipidemia - E78.5
[insert plan]

4. Hypertension - I10
[insert plan]

5. CKD, stage 3, unspecified - N18.30
[insert plan]

Now, my question is, would you change I10 to I12.9? would you seek the approval of the physician before changing to this code? Other than the provider stating they were unrelated, is there another reason why you would not change to I12.9?

I know the guidelines are plain as day with the following: " ..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 (I. C. 9. a)." I'm asking how you as the coder would handle this scenario.

Thank you in advance, I appreciate all the feedback!!

 

[lgardner]

the answers are in your ICD code book.

the guidelines in the beginning of Chapter 9 state:
"Assign codes from category I12, Hypertensive CKD, when both hypertension and a condition classifiable to category N18, CKD, are present. CKD should not be coded as hypertensive if the provider indicates the CKD is not related to the hypertension..."

if you look up the CKD- N18.**- the instructions read:
"code first any associated:
diabetic CKD
hypertensive chronic kidney disease..."

so, yes. as a coder, you can, absolutely, change I10 to I12.9.

 

[TThivierge]

Hi Lindsay
Yes I d add dx I12.9 from dx I10 from question above. Here are more tips on sequencing...you know follow physician lead on his assessments/dx listed per current medical notations. Add dx Z72 or F17 smoking if he mentions current smoking. Patient with chronic conditions of HTN, cardiac I50, respiratory or gastro problems such as K21 add the smoking dx if mentioned or if past History of Nicotine dx Z87.891. If pt. has history of cardiac pacemaker, amputations, or ostomy bags mentioned add these Z dx too if related to current illness. If pt has infections from UTI dx N39 add B95-B97 dx codes .Instruction from ICD10 manual states to add it. Or gastro problems add infections such as K25 gastric ulcer from drinking then add F10 too. Or stomach infection add dx B96.81 if lab results back it up. Or patient has sore throat but lab results shows infection J02.8 add B95-B97 per lab results if applicable.
Understand difference in first listed Z dx codes vs. other Z dx codes in certain settings.
Add lateral CPT or dx code for bilateral organs such as eyes, ears, kidneys, arms, limbs, glands...hopefully provider will specific this factor.
Be careful of Excludes 1 rule with dx coding
If provider states pt. has CHRONIC pain written in note associated with a limb sequence as one of dx blocks M25.561 right knee, then next dx code under it should be G89.29
I hope I helped you in dx sequencing a bit. Please let me know if this message helped you
Have a good day!
Lady T