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AGPCARE-0074-
Chronic Kidney
Disease
(Category N18)
ICD-10-CM
Coverage provided by Amerigroup Inc. This publication contains proprietary information. This material is for informational purposes only. Reference the Centers for Medicare and Medicaid Services (CMS) for more information on Risk Adjustment and the CMS-HCC Model. Redistribution or other use is strictly forbidden This publication is for informational purposes only and is not guaranteed to be without defect. Please reference the current version(s) of the ICD-10-CM codebook, CMS-HCC Risk Adjustment Model, and AHA Coding Clinic for complete code sets and official coding guidance. 62679MUPENABS 09/15/
Chronic Kidney Disease (CKD) is a condition characterized by a gradual loss of kidney function over time as defined by the National Kidney Foundation.
Characteristics of CKD
Kidney disease is considered to be a silent disease
because it often has no symptoms and can go unnoticed until it is very advanced. Timely detection and treatment can slow and prevent the progression of kidney disease.
When kidney function is compromised, it is defined
as renal/kidney failure.
The decrease in renal function can evolve very
slowly or very fast. Chronic failure progresses gradually over at least 3 months and can lead to permanent renal failure.
CKD has countless causes with diabetes mellitus
(DM) and hypertension (HTN) being the most frequent.
The diagnosis of CKD involves at least two abnormal
markers of damage or two anomalous glomerular filtration rates (GFRs) persisting for more than 3 months.
CKD is staged accordingly to GFR with formulas
designed for infant/children and for adults. Those stages show the progressive severity.
CKD facts
HTN causes CKD, and CKD causes HTN.
Persistent proteinuria (i.e., protein in urine)
indicates CKD is present.
Kidneys have a higher blood flow than the brain,
liver or heart.
Every 30 minutes, kidneys filter all the blood in the
body, removing waste and excess fluid.
A person can lose up to 90% of their kidney function
before experiencing any symptoms.
Once the kidneys fail, dialysis or a kidney transplant
is required.
Coding CKD
When it comes to coding for CKD, there is not much difference between ICD-9 and ICD-10. The ICD-10-CM classifies CKD based on severity, which is designated by stages 1-5, and end-stage renal disease (ESRD) based on GFR values and dialysis treatment. When coding for patients with both acute renal failure and CKD, an additional code for acute renal failure is required. Often, the CKD stage codes are secondary to a code for the underlying cause of CKD, such as hypertensive kidney disease or diabetes with kidney complication.
CKD classification
Stage 1 90-130 mL/min Stage 4 15-29 mL/min Stage 2 60-89 mL/min Stage 5 <15 mL/min Stage 3 30-59 mL/min ERSD Dialysis Stage Code Description Stage 1 N18. Slightly diminished function, kidney damage with normal or relative high GPR Stage 2
N18.2 =
mild CKD Mild reduction in GPR with kidney damage Stage 3
N18.3 =
moderate CKD Moderate reduction in GFR Stage 4
N18.4 =
severe CKD Severe reduction in GFR, preparation for renal replacement therapy Stage 5 N18. Established kidney failure or permanent renal replacement therapy (RRT), excludes CKD stage 5 requiring dialysis ERSD N18. Patients with CKD requiring dialysis CKD and ERSD N18.6 only If kidney transplant
Z94.
On dialysis treatment
Z99.
Code assignments based on physician documentation of the specific stage and not the GFR alone.
CKD and hypertension
A. ICD-10-CM coding guidance
The ICD-10-CM code book does not have a hypertension table in the index. One reason is the reference to terms malignant and benign hypertension were removed as they were considered outdated. All three previous designations in ICD-9 are now reported with just one ICD-10 code for essential hypertension, code I10.
CKD and kidney transplant
Patients with a kidney transplant may still suffer some type of CKD as the transplant may not completely reinstate kidney function. Thus, having CKD alone does not mean that there is a transplant complication. Assign a code to establish the stage of CKD (N18 category) and kidney transplant status (Z94.0). If a complication resulting from the transplant (e.g., failure or rejection) is clearly documented, it would be appropriate to code the complication of kidney transplant from subcategory T86.1-. CKD coding examples
Patient has hyperkalemia due to CKD.
ICD-10-CM: hyperkalemia (E87.5), CKD unspecified (N18.9)
A patient is seen for diabetic CKD, stage 3. The
patient has type 2 diabetes and takes insulin on a daily basis. ICD-10-CM: type II DM with CKD (E11.22), CKD stage 3 (N18.3), insulin use (Z79.4)
Patient has hypertensive heart disease and ESRD.
He also was diagnosed with heart failure. ICD-10-CM: hypertensive heart disease, with heart failure, ESRD (I13.2), ESRD (N18.6), heart failure (I50.9)
A patient has chronic systolic (congestive) heart
failure due to hypertension with stage 5 CKD. ICD-10-CM: hypertensive heart disease with heart failure and CKD 5 (I13.2), CKD 5 (N18.5), chronic systolic (congestive) heart failure (I50.22)
Patient has hypertension and ESRD, on dialysis
three times a week. ICD-10-CM: hypertensive ESRD (I12.0), ESRD (N18.6), dialysis status (Z99.2)
Patient receives treatment of DM, type 2. Patient is
also on hemodialysis for ESRD. ICD-10-CM: type II DM with ESRD (E11.22), ESRD (N18.6), dialysis status (Z99.2) Rationale: In ICD-10-CM, there is an assumed relationship with ESRD and diabetes, unless documentation states otherwise. References Renal Business, Coding for Chronic Kidney Disease Under the ICD-10-CM Code Set (2011): renalbusiness.com Ahima HIM Body of Knowledge (May 2015): ahima.org Kidney Disease, Improving Global Outcomes, Controversies Conference (2015): kdigo.org Procrit Epoetin Alfa, Procrit ICD-10 Nephrology (May 2015): procritline.com Capstone Performance Systems, Diagnosing and Coding for Chronic Kidney Disease (2015): capstoneperformancesystems.com Code it Right Online, Case Study: How to Code Hypertensive Heart, Kidney Disease in ICD-10 (August 14, 2014): codeitrightonline.com The Renal Association, CKD Stages (May 2015): renal.org United States Renal Data System (May 2015): usrds.org Medical Practice Insider (May 2015): medicalpracticeinsider.com Anita Schmidt, K.K., & P.W. (2016): ICD-10-CM Expert for Physicians. Optum 360
