ICD-9-CM and CPT
By Therese M. Jorwic, MPH, RHIA, CCS, CCS-P
More than 26 million adults in the U.S. have chronic kidney disease, or CKD. Millions more are at risk.
Determining the extent of damage is usually done by testing the glomerular filtration rate, or GFR, which indicates the level of kidney function.
And detection needs to be early, because left alone, the disease allows waste to build up, causing hypertension, anemia, weak bones, and nerve damage. It increases the risk of heart and blood vessel disease. And eventually it leads to kidney failure.
CKD is related to a number of other disorders, but most commonly to diabetes and hypertension, which account for about two thirds of the cases.
The symptoms are fatigue, low energy, poor concentration, loss of appetite, sleep issues, muscle cramping at night, swollen feet and ankles, puffy eyes, itchy dry skin, and a frequent need to urinate, especially at night.
Coding today with ICD-9
Here’s a look at the coding today and tomorrow, starting with ICD-9-CM. In the current code system, CKD is coded at category 585 with fourth digits to show the stage of the disease:
585.1 – stage I – GFR >90
585.2 – stage II (mild) GFR 60-89
585.3 – stage III (moderate) GFR 30-50
585.4 – stage IV (severe) GFR 15-29
585.5 – stage V (kidney failure) GFR <15
585.6 – end stage renal disease – patient requires ongoing dialysis
585.9 – unspecified
A note here says that when the patient has both CKD and hypertension, the hypertensive CKD gets coded first. That’s because there is a presumed cause-and-effect relationship between the two.
The hypertensive CKD is coded at category 403. And if there is heart disease as well, the category is 404.
In each of those categories, there is a fourth digit to show if the disease is malignant, benign, or unspecified.
There are also fifth digits.
For hypertensive CKD (category 404), they are
0 – with CKD, stage I-IV or unspecified
1 – with CKD, stage V or ESRD
And for hypertensive heart and chronic kidney disease (category 404), they are
0 – no heart failure, CKD stage I-IV or unspecified
1 – heart failure and CKD stage I-IV pr unspecified
2 – no heart failure and CKD stage V or ESRD
3 – heart failure and CKD stage V or ERSD
From there, go to the 585 codes to show the actual stage of the CKD.
Four points:
• If the patient is at stage V but requires chronic dialysis, code it as ESRD.
• If the patient has had a kidney transplant, show that with code V42.0
• There is also a separate code – V45.11 – to show that the patient is receiving dialysis.
• And there is another code – V45.12 – to show noncompliance with the dialysis.
Coding tomorrow with ICD-10
The ICD-10 coding is quite similar.
CKD is found in category N18, and just as with the current codes, there are characters 1-6 and 9 to identify the stage of the disease. The stages are the same, and once again, the notes say that stage V requires ongoing dialysis.
With dialysis status, there is a small difference.
The ICD-10 notes say to use an additional code to show the status, which means the extra code is required. By contrast, ICD-9 has a status code but no stated requirement to use it.
The ICD-10 code for transplant status is Z94.0. For dialysis status, it is Z99.2. And for noncompliance with the dialysis, the code is Z91.15. (For the most part, ICD-9’s V codes are ICD-10’s Z codes.)
There is also another note on code sequencing. With ICD-10, code first any CKD associated with diabetes or hypertension.
For diabetic CKD, the codes are in the E category, which covers endocrine and metabolic diseases. They are E08.22, E09.22, E10.22, E11.22, and E13.22.
For hypertensive CKD, they are in the I category, which covers diseases of the circulatory system. They are II2.- and II3.-. (The – shows that another character follows. In ICD-9, that’s usually shown with an x as in 585.x.)
Therese M. Jorwic, MPH, RHIA, CCS, CCS-P, is assistant professor of health information management at the University of Illinois at Chicago and senior consultant for MC Strategies in Atlanta.
