Complications of CKD include early death and heart disease.
Chronic kidney disease (CKD) affects 15 percent of United States adults, or 37 million people, according to a recent statement by the Centers for Disease Control and Prevention (CDC). The following are some basic facts about CKD; specifically, it is:
The risk factors for CKD include diabetes, hypertension, heart disease, obesity, family history of CKD, prior history of kidney damage, and older age. Diabetes and hypertension are the major risk factors for CKD.
CKD damages the kidneys over time so the kidneys can no longer clean the blood as they should. The result is that the wastes and extra water accumulates in the body, and other health problems occur. CKD has five stages, including end stage renal disease (ESRD). The complications of CKD include early death, heart disease, stroke, anemia, low blood calcium, high potassium, loss of appetite, extra fluid in the body, infections, and depression. The CDC recommends the following habits to prevent CKD:
The coding for CKD begins at category N18, which captures the stages. N18.1-N18.5 are used to specify CKD stage 1 through stage 5. N18.6 is coded for ESRD. N18.9 is the ICD-10-CM code for unspecified CKD. This code would be a focus of clinical documentation improvement, as stages 4 and 5 are complication/comorbidity (CC) diagnoses, and ESRD is a major complication/comorbidity (MCC). From the Hierarchical Condition Category (HCC) perspective: N18.3 (stage 3) N18.6 (ESRD) codes are HCCs, so the stage will impact the HCC status.
CKD with hypertension is coded based on the CKD stage as well. I12.0 with N18.5/N18.6 is the combination of CKD and hypertension with the second code indicating ESRD or CKD stage 5. I12.9 with N18.1-N18.4 or N18.9 is hypertension with CKD stages 1-4 or unspecified. CKD with chronic heart disease and hypertension is classified with a combination of codes. I13.0 is hypertension with heart failure and CKD stages 1-4 or unspecified. I13.10 is hypertension without heart failure and CKD stages 1-4 or unspecified. I13.11 is hypertension without heart failure and CKD stages 5, or ESRD. I13.2 is hypertension with heart failure and CKD stage 5 or ESRD. Additional codes are assigned for the specific CKD stage and I50.- for heart failure, if present.
Complications of kidney transplant, which can be a treatment for CKD, are found in the subcategory of T86.1. Please note the instructional notes at the category level. If a patient has a history of a kidney transplant, then assign Z94.0. While most transplant statuses are HCCs, Z94.0 is only an Rx-HCC, not a CMS-HCC. Z94.0 is important as it is a CC for inpatients.
Clinical documentation specialists, inpatient coders, and risk adjustment coders should be very acquainted with the CKD codes as well as the condition’s clinical aspects. These diagnosis codes impact MS-DRGs and HCCs. The skills of clinical documentation specialists and coders are required to achieve highest appropriate reimbursement.
Resources:
Centers for Medicare & Medicaid Services (CMS) Mid-Year 2019 HCC Mappings, https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors.html?DLSort=0&DLEntries=10&DLPage=1&DLSortDir=descending
Centers for Medicare and Medicaid Services (CMS) v36 Table J (Complete List of CCs) and Table I (Complete List of MCCs). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Final-Rule-Home-Page-Items/FY2019-IPPS-Final-Rule-Tables.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending
Centers for Disease Control and Prevention: https://www.cdc.gov/kidneydisease/index.html
Coding in the post-acute care world has taken on a new significance in the past five years. For those of us who are coders, this
External audit volume more than doubled in 2024 over 2023 while total at-risk dollars increased fivefold to $11.2 million, impacting healthcare provider organizations’ cash flow
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
