The Centers for Medicare & Medicaid Services (CMS) Office of Minority Health (OMH) has announced that March is National Kidney Month.
Chronic kidney disease (CKD) affects 14 percent of adults in the United States. Risk factors for CKD include hypertension, diabetes, obesity, and heart disease. The OMH states that Black Americans are more affected by the disease, at 20 percent. Asian Americans and Hispanic Americans are affected by CKD at the same rate – 14 percent.
The coding of CKD can be found in Chapter 14 (Diseases of the Genitourinary System); the codes begin with “N”. This condition is affected by the Official Coding and Reporting Guidelines of I.A.15 (With). This guideline states, “the word ‘with’ or ‘in’ should be interpreted to mean ‘associated with’ or ‘due to’ when it appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List.”
The ICD-10-CM FY2024 Index for CKD shows the following coding options:
When coding chronic kidney disease, first, the stage needs to be specific in code assignment. The next step is to identify any related conditions, such as hypertension, pregnancy, or schistosomiasis.
If the patient has hypertension of chronic kidney disease, the coder is instructed to look at the entry of Hypertension, kidney. The Index displays this information:
If the patient has Stage 3 CKD and hypertension, then the coder would assign I12.9. The coder should open the ICD-10-CM Tabular volume to I12, which shows the following information:
The Tabular volume under code I12.9 directs the coder to also assign a code from the N18.1-N18.4 or N18.9, based on the CKD stage. In this case, the coder would assign N18.30, as there is no further specificity. This lack of documentation would be an opportunity for provider education, as well as a query to request the documentation. The Tabular volume shows this information for N18.3:
If the provider documents in the patient’s chart that the patient has CKD Stage 3a, or “hypertension, CKD IIIa,” then the coder should assign I12.9 and N18.31 for hypertensive CKD. The guidelines state that the relationship between hypertension and chronic kidney disease may be assumed.
The use of the preposition “with” is one difficult concept to understand for new coders. That concept is used when coding hypertension with CKD. Make sure that you are coding CKD correctly as we recognize National Kidney Month.
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