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HTN with CKD and DM

  1. Default HTN with CKD and DM
    Medical Coding Books
    If HTN, CKD, and DM are documented. Can you link HTN to CKD and DM or does it have to be linked to just one if not specifically documented as due to one or the other.

  2. #2
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    Columbia, MO
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    Default
    you link it to both

    Debra A. Mitchell, MSPH, CPC-H

  3. Default HTN with CKD and DM
    Ok, so wait---even if the 'link' to these chronic conditions are not mentioned/documented, you're saying to still link them?

  4. #4
    Default Who's on First? DM or HTN with CKD
    My understanding is that it all depends on the ICD code description and whether or not the word "with" and/or "and" is part of the description. For diagnosis that contain the words "with" or "and" there does not have to be a documented relationship. If the formal ICD description does not contain "with" and/or "and", and cause/effect must be documented.

    The problem is, or what makes coding CKD confusing to me is, that the instructions say 'first code any associated": Diabetic CKD, Hyertensive CKD

    which is fine if your patient is diabetic patient with Diabetic CKD or your patient is hypertensive with Hypertensive CKD BUT

    what about a diabetic patient with hypertensive CKD or a hypertensive patient with Diabetic CKD

    or a diabetic patient with hypertension secondary to their diabetes and then develops CKD secondary to their secondary hypertension.

    I sat down, just last night and made myself a cheat sheet but haven't used it at work yet because I was worried I'm overthinking this..........................

    Let's discuss.........................
    Attached Files Attached Files

  5. #5
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    Columbia, MO
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    Quote Originally Posted by gwykes@austin.rr.com View Post
    Ok, so wait---even if the 'link' to these chronic conditions are not mentioned/documented, you're saying to still link them?
    Yes , read your guidelines. If the key term or sub term is followed by the word with, then the conditions indented under the word with, are automatically causal to the key or subterm.
    Diabetes, type 1 or type 2 with CKD is an automatic causal condition and per coding guidelines does not have to be stated as linked by the provider in the document. Hypertension is also followed by the word with and indented under with is CKD. So yes you code them as linked without the provider documenting as such.
    Coding clinics have addressed in many publications the issue of. CKD with both diabetes and HTN and they instruct that unless otherwise documented you code them both as linked.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    Try to keep it simple here, just follow the alphabetic index and it will take you to the right codes: CKD is listed under both 'hypertension' and 'diabetes' in the alphabetic index and so has a presumed relationship to each of these due to the 'with' term that appears there.

    1) The hypertension has to be coded from category I12 since the patient has a documented CKD diagnosis (Hypertension --> with --> kidney involvement --> see Hypertension, kidney, etc.).

    2) Similarly, the diabetes has to be coded from E11.22 since the patient has a documented CKD diagnosis (Diabetes --> with --> chronic kidney disease --> E11.22).

    3) Then the CKD is coded from N18 as usual, with the I12 and E11.22 diagnosis codes above listed first per the 'code first' note.
    Thomas Field, CPC, CEMC

  7. #7
    Location
    Columbia, MO
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    13,215
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    Quote Originally Posted by talton0206 View Post
    My understanding is that it all depends on the ICD code description and whether or not the word "with" and/or "and" is part of the description. For diagnosis that contain the words "with" or "and" there does not have to be a documented relationship. If the formal ICD description does not contain "with" and/or "and", and cause/effect must be documented.

    The problem is, or what makes coding CKD confusing to me is, that the instructions say 'first code any associated": Diabetic CKD, Hyertensive CKD

    which is fine if your patient is diabetic patient with Diabetic CKD or your patient is hypertensive with Hypertensive CKD BUT

    what about a diabetic patient with hypertensive CKD or a hypertensive patient with Diabetic CKD

    or a diabetic patient with hypertension secondary to their diabetes and then develops CKD secondary to their secondary hypertension.

    I sat down, just last night and made myself a cheat sheet but haven't used it at work yet because I was worried I'm overthinking this..........................

    Let's discuss.........................
    I think you are confused. The provider does not need to document diabetic CKD or hypertensive CKD and in most cases they do not. So the question was if the documentation states CKD and also indicates HTN and indicates diabetes do you link the CKD to both. The answer is yes CKD is automatically causal to diabetes and also to HTN. If the provider does not want these conditions to be linked then the provider must document for instance that the CKD is NOT due to the diabetes.
    The word with is not found in the code description or in the provider documentation, the word ‘with’ which links these conditions is found in the alpha section of the code book.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Default
    Ooooooo...... the important "with" is hiding in the index! Yes, I was thoroughly confused. Thank you all.

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