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DM Nephropathy with CKD and HTN

  1. Default DM Nephropathy with CKD and HTN
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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

  2. #2
    Location
    Columbia, MO
    Posts
    12,892
    Default
    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.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    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

  4. Default
    Is the "diabetic nephropathy" separate from the CKD?

  5. Default
    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

  6. #6
    Location
    Columbia, MO
    Posts
    12,892
    Default
    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.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Default
    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

  8. Default
    Quote Originally Posted by tharal View Post
    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
    403.90,585.3,583.81

  9. Wink dm link HTN AND NEPRHOPATHY
    250.40,585.3,583.81,403.90=dm.ckd,nephropathy,htn
    Last edited by mxm9314; 05-27-2014 at 06:13 PM. Reason: MISTAKE

  10. Default
    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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