MaryW_64032
Member
If a pt is coming in for dialysis ESRD and they have DM and HTN
what code should go first
E11.22, N186, I120,
thank you
what code should go first
E11.22, N186, I120,
thank you
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Resolved Code Placement
- Thread starter MaryW_64032
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Lori
Well-known member
The sequencing for the principal diagnosis would be based on the condition noted in the documentation as the primary reason for the patient’s visit and/or procedure.
If both conditions meet the definition for assignment as the principal diagnosis, per the fiscal year 2020 ICD-10-CM Official Guidelines for Coding and Reporting, then either condition can be assigned as the principal diagnosis.
If this is the case, then you have the option of reporting either E11.22 (Type 2 diabetes mellitus with diabetic chronic kidney disease) or a code from category I12.- (hypertensive chronic kidney disease) first.
ICD-10-CM assumes a cause-and-effect relationship between CKD and HTN, as well as CKD and diabetes.
CKD is most likely related to both the HTN and the diabetes when all three conditions are present. High blood pressure and high blood sugar in the blood vessels can lead to the deterioration of the vessels, which can then cause damage to the kidneys.
CKD should not be assigned as hypertensive if the provider’s documentation specifies that the CKD is not related to the hypertension. Always query if the physician’s documentation seems unclear, but based on the information given, I would report the following ICD-10-CM codes for this patient’s encounter:
Coding Tips:
1) Document the stage of the CKD N18.1-N18.5 (stages 1-5).
2) Document N18.5 if the patient has CKD stage 5, but not yet requiring or electing dialysis.
3) Do not use N18.5 CKD stage 5 if the patient has ESRD and is on dialysis.
4) Document N18.6 (end stage renal disease) if the patient has CKD stage 5 and requires dialysis.
5) Document Z99.2* (dependence on renal dialysis) for patients on dialysis after also documenting N18.6 (end stage renal disease).
These conditions must be documented together in the medical record.
When there are two or more interrelated conditions (such as diseases in the same ICD-10-CM chapter or manifestations characteristically associated with a certain disease) potentially meeting the definition of principal diagnosis, either condition may be sequenced first, unless the circumstances of the admission, the therapy provided, the Tabular List, or the Alphabetic Index indicate otherwise.
Code E11.22, Type 2 Diabetes mellitus with diabetic chronic kidney disease, also has a “use additional code” to identify the stage of the chronic kidney disease (N18.1-N18.6). If both the diabetes and HTN are identified as contributing to the ESRD, there is nothing wrong with coding both combinations. If it appears the patient will now be dialysis dependent, make sure it’s documented
Diabetes mellitus with complication The combination code for diabetes includes the type of diabetes, the body system that is affected and the specific complication affecting that body system. There is an assumed cause-and-effect relationship between diabetes and certain conditions (such as but not limited to: cataract, dermatitis, gastroparesis, chronic kidney disease, osteomyelitis, retinopathy and [poly]neuropathy) as these specific conditions are listed under the term “with” in the Alphabetic Index.2
Hypertension, heart and kidney disease The classification also presumes a causal relationship between hypertension and certain heart and/or kidney diseases. If a heart condition (such as but not limited to: cardiomegaly, heart failure, myocardial degeneration and myocarditis) is documented with hypertension, a combination code from category I11 — hypertensive heart disease — should be reported. If heart failure is present, documentation needs to detail the type of heart failure in order to assign the most specific code from category I50 — heart failure. If chronic kidney disease is documented with hypertension, a combination code from I12 — hypertensive chronic kidney disease — should be reported. Documentation needs to identify the stage as 1-5 or end stage renal disease (ESRD) in order to report an additional code from category N18 — chronic kidney disease. If the patient is currently receiving dialysis, it would be appropriate to also code Z99.2 — dependence on renal dialysis. If hypertension, heart failure and chronic kidney disease are all documented, use a combination code from category I13 — hypertensive heart and chronic kidney disease. These are just a few examples of conditions that have an assumed causal relationship in ICD-10-CM.
EXAMPLES:
acdis.org
You may also want to code:
If both conditions meet the definition for assignment as the principal diagnosis, per the fiscal year 2020 ICD-10-CM Official Guidelines for Coding and Reporting, then either condition can be assigned as the principal diagnosis.
If this is the case, then you have the option of reporting either E11.22 (Type 2 diabetes mellitus with diabetic chronic kidney disease) or a code from category I12.- (hypertensive chronic kidney disease) first.
ICD-10-CM assumes a cause-and-effect relationship between CKD and HTN, as well as CKD and diabetes.
CKD is most likely related to both the HTN and the diabetes when all three conditions are present. High blood pressure and high blood sugar in the blood vessels can lead to the deterioration of the vessels, which can then cause damage to the kidneys.
CKD should not be assigned as hypertensive if the provider’s documentation specifies that the CKD is not related to the hypertension. Always query if the physician’s documentation seems unclear, but based on the information given, I would report the following ICD-10-CM codes for this patient’s encounter:
Coding Tips:
1) Document the stage of the CKD N18.1-N18.5 (stages 1-5).
2) Document N18.5 if the patient has CKD stage 5, but not yet requiring or electing dialysis.
3) Do not use N18.5 CKD stage 5 if the patient has ESRD and is on dialysis.
4) Document N18.6 (end stage renal disease) if the patient has CKD stage 5 and requires dialysis.
5) Document Z99.2* (dependence on renal dialysis) for patients on dialysis after also documenting N18.6 (end stage renal disease).
These conditions must be documented together in the medical record.
When there are two or more interrelated conditions (such as diseases in the same ICD-10-CM chapter or manifestations characteristically associated with a certain disease) potentially meeting the definition of principal diagnosis, either condition may be sequenced first, unless the circumstances of the admission, the therapy provided, the Tabular List, or the Alphabetic Index indicate otherwise.
Code E11.22, Type 2 Diabetes mellitus with diabetic chronic kidney disease, also has a “use additional code” to identify the stage of the chronic kidney disease (N18.1-N18.6). If both the diabetes and HTN are identified as contributing to the ESRD, there is nothing wrong with coding both combinations. If it appears the patient will now be dialysis dependent, make sure it’s documented
Diabetes mellitus with complication The combination code for diabetes includes the type of diabetes, the body system that is affected and the specific complication affecting that body system. There is an assumed cause-and-effect relationship between diabetes and certain conditions (such as but not limited to: cataract, dermatitis, gastroparesis, chronic kidney disease, osteomyelitis, retinopathy and [poly]neuropathy) as these specific conditions are listed under the term “with” in the Alphabetic Index.2
Hypertension, heart and kidney disease The classification also presumes a causal relationship between hypertension and certain heart and/or kidney diseases. If a heart condition (such as but not limited to: cardiomegaly, heart failure, myocardial degeneration and myocarditis) is documented with hypertension, a combination code from category I11 — hypertensive heart disease — should be reported. If heart failure is present, documentation needs to detail the type of heart failure in order to assign the most specific code from category I50 — heart failure. If chronic kidney disease is documented with hypertension, a combination code from I12 — hypertensive chronic kidney disease — should be reported. Documentation needs to identify the stage as 1-5 or end stage renal disease (ESRD) in order to report an additional code from category N18 — chronic kidney disease. If the patient is currently receiving dialysis, it would be appropriate to also code Z99.2 — dependence on renal dialysis. If hypertension, heart failure and chronic kidney disease are all documented, use a combination code from category I13 — hypertensive heart and chronic kidney disease. These are just a few examples of conditions that have an assumed causal relationship in ICD-10-CM.
EXAMPLES:
Q&A: Reporting diabetes, CKD, and HTN in ICD-10-CM | ACDIS
We had a patient with Type 2 diabetes who was admitted for hypoglycemia with metabolic encephalopathy. The patient also had stage 2 chronic kidney disease (CKD) and a diagnosis of hypertension (HTN). Which ICD-10-CM codes should we assign for this patient’s encounter?
acdis.org
| Question: Since ICD-10-CM presumes a relationship between both chronic kidney disease (CKD) and hypertension as well as diabetes mellitus and CKD, what are the appropriate code assignments when the provider documents type 2 diabetic mellitus with chronic kidney disease and the patient also has a diagnosis of hypertension? | |
| Codes: E11.22 Type 2 DM with diabetic chronic kidney disease I12.9 Hypertensive CKD with stage 1 through stage 4 CKD, or unspecified CKD N18.9 Chronic |
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