ICD-10 requires physicians to code with a much higher level of specificity. This resource covers ICD-10 codes for specific conditions and requirements including renal failure, causative codes, diabetes, glomerular disease, hypertensive chronic kidney disease, anemia, adverse effects, poisonings or toxic effects, complications of care and body mass index.
As of October 1, 2016 Greater Specificity is REQUIRED!
Medicare and many private payers are going to decrease the ability to submit less specified codes without penalty
In order to bill a more specific diagnosis you need to start documenting more detail. ICD-10 codes require that you document:
Onset of Care
Anatomical Site Specificity
Laterality
Disease Severity
Etiology & Manifestation
Complications
Combination Codes
Non-Specific/Unspecified
Conditions that may add complexity to treatment
REMEMBER:
Avoid “over-coding”
Additional codes should be reported when required by coding conventions
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• code also |
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2 or more codes may be required to fully describe a condition |
Identify if renal failure is acute or chronic renal failure
Acute Renal Failure with:
• Tubular necrosis
• Acute cortical necrosis
• Medullary necrosis
• Other acute kidney failure
Stage of Chronic Kidney Disease: Stage 1-5
End-Stage Renal Disease
• Compliant with dialysis
• Non-compliant with dialysis
Identify any associated diabetic or hypertensive chronic kidney disease
Code also associated underlying condition
N17.0 – AKF with tubular necrosis
N17.1 – AKF with acute cortical necrosis
N17.2 – AKF with medullary necrosis
N17.8 – Other acute kidney failure
N17.9 – Acute kidney failure, unspecified
N18.1 – Chronic Kidney Disease, Stage 1
Other Renal
Q61.2 – Polycystic kidney adult type
Q61.5 – Medullary cystic kidney
R34 – Anuria & oliguria
R31.0 – Hematuria, gross
R31.9 – Hematuria, unspecified
N18.2– Chronic Kidney Disease, Stage 2
N18.30 – Chronic Kidney Disease, Stage 3 unspecified
N18.31 – Chronic Kidney Disease, Stage 3a
N18.32 – Chronic Kidney Disease, Stage 3b
N18.4 – Chronic Kidney Disease, Stage 4
N18.5 – Chronic Kidney Disease, Stage 5
N18.6 – End Stage Renal Disease requiring dialysis
Use additional code to identify dialysis status (Z99.2)
•Z91.15 – Noncompliance with renal dialysis
Code first any associated:
•Diabetic CKD (E08.22, E09.22, E10.22, E11.22, E13.22)
•Hypertensive CKD (I12.X, I13.X)
Use additional code to identify kidney transplant status, if applicable (Z94.0)
As of Date of Service October 1, 2016
Causative codes must be documented when using N17.0 – N17.9 “Kidney Failure” or N18.1-N18.5 “CKD” or N18.6 “ESRD”
(For all place of services)
Diabetes Glomerular Disease HypertensionIf the causative reason cannot definitively be determined, it would be appropriate to use: N19 Unspecified Renal Failure N17.9 Acute Kidney Failure, Unspecified N26.1 Atrophy of Kidney – TerminalSymptom codes such as the following could be used depending upon what is known from the office visit or referral data. R31.9 Hematuria R80.9 Proteinuria Document the type, any complications or manifestations and the current treatment
Identify when diabetes is accompanied by hyperglycemia or hypoglycemia
State if hypoglycemia results in coma
If there are complications/manifestations of the diabetes, additional details may be necessary for the following conditions:
• Arthropatphy
• Site of Ulcer
• Severity of retinopathy
• With or without macular edema
• Stage of CKD
• Gangrene
• Hyperglycemia
Use additional code to identify any insulin use (Z79.4)
Type I
E10.21 – Type I DM with Diabetic Nephropathy
E10.22 – Type l DM with Diabetic CKD
Use additional code to identify stage of CKD (N18.1 – N18.6)
E10.29 – Type I DM with other Diabetic Kidney Complications such as DM with Renal Tubular Degeneration
Type II
E11.21 – Type II DM with Diabetic Nephropathy
E11.22 – Type Il DM with Diabetic CKD
Use additional code to identify stage of CKD (N18.1 –N18.6)
E11.29 – Type II DM with other Diabetic Kidney Complications such as DM with Renal Tubular Degeneration
E08.21 – DM due to underlying condition with Diabetic Nephropathy
E08.22 – DM due to underlying condition with Diabetic Chronic Kidney Disease
Code first the underlying condition such as malignant neoplasm (C00 – C96)
Use additional code for stage of CKD (N18.1-N18.6) Use additional code for any insulin use (Z79.4)
E16.2 – Hypoglycemia unspecified
Code also any associated kidney failure N17-N19
Third Digit
N00 – Acute nephritic syndrome
N01 – Rapidly progressive nephritic syndrome
N02 – Recurrent and persistent hematuria
N03 – Chronic nephritic syndrome
N04 – Nephrotic syndrome
N05 – Unspecified nephritic syndrome
N06 – Isolated proteinuria with specified morphologic lesion
N07 – Hereditary nephropathy NEC
Fourth Digit N00-N07
.0 with minor glomerular abnormality
.1 with focal and segmental glomerular lesions
.2 with diffuse membranous GN
.3 with diffuse mesangial proliferative GN
.4 with diffuse endocapillary proliferative GN
.5 with diffuse mesangiocapillary GN
.6 with dense deposit disease
.7 with diffuse crescentic GN
.8 with other morphologic changes
.9 with unspecified morphologic changes
M32.14 SLE GN • M32.15 SLE tubular-interstitial • D59.3 HUS
M31.0 Goodpasture Syndrome • M31.31 Wegeners
N08 Glomerular disorders in diseases classified elsewhere
Glomerulonephritis
Nephritis
Nephropathy
Code First: underlying disease, such as:
• amyloidosis (E85.-)
• congenital syphilis (A50.5)
• cryoglobulinemia (D89.1)
• disseminated intravascular coagulation (D65)
• gout (M1A.-, M10.-)
• microscopic polyangiitis (M31.7)
• multiple myeloma (C90.0-)
• sepsis (A40.0-A41.9)
• sickle-cell disease (D57.0-D57.8)
Excludes: glomerulonephritis, nephritis and nephropathy (in):
• antiglomerular basement membrane disease (M31.0)
• diabetes (E08-E13 with .21)
• gonococcal (A54.21)
• Goodpasture’s syndrome (M31.0)
• hemolytic-uremic syndrome (D59.3)
• lupus (M32.14)
• mumps (B26.83)
• syphilis (A52.75)
• systemic lupus erythematosus (M32.14)
• Wegener’s granulomatosis (M31.31)
• pyelonephritis in diseases classified elsewhere (N16)
If hypertension and chronic kidney disease are present, report as hypertensive chronic kidney disease
I10 Essential (primary) Hypertension
I12 Hypertensive chronic kidney disease
I12 is a code family requiring a 4th digit
Excludes 1: hypertension due to kidney disease (I15.0, I15.1)
• Secondary hypertension (I15.-)
Excludes 2: acute kidney failure (N17.-)
Includes: any condition in N18 and N26 – due to hypertension
• Arteriosclerotic nephritis (chronic)(interstitial)
• Hypertensive nephropathy
• Nephrosclerosis
I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 Hypertensive chronic kidney disease stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
• Hypertensive renal disease NOS
• Use additional code to identify the stage of chronic kidney disease (N18.1 – N18.4, N18.9)
I13 – Hypertensive heart and chronic kidney disease I13 is a code family requiring a 4th digit
Includes: any condition in I11. – With any condition in I12. –
• Cardiovascular renal disease
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease
• Use additional code to identify stage of chronic kidney disease (N18.1 – N18.4, N18.9)
I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic
• Use additional code to identify the stage of chronic kidney disease (N18.1 – N18.4, N18.9)
I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
• Use additional code to identify the stage of chronic kidney disease (N18.5, N18.6)
What is the deficiency due to?
Vitamin(s) MineralsYou need to document the following for Anemia:
Type of Anemia:
• Hemolytic
• Aplastic
• Result of Blood Loss
• Acute or Chronic
Link Laboratory Findings to a related diagnosis
Cause OR provide a statement indicating the “unknown cause”
List the name & purpose of medications or other substance causing anemia
D50.0 – Chronic Blood Loss Anemia
D50.9 – Iron Deficiency Anemia
D61.9 – Aplastic Anemia
D62 – Acute blood loss Anemia
D63.1 – Anemia in chronic kidney disease
Document the substance causing the complications or manifestations
Identify complications or manifestations caused by a substance:
• Convulsions
• Anaphylactic reaction
Specify any external causes
Provide information regarding the circumstances surrounding the event, or mindset of the patient to help identify if the event was accidental, intentional or the result of an assault
Complications of care are based solely on the provider’s documentation of the relationship between the condition and the care or procedure Must be stated by the provider that the condition is a complication – Can’t be assumedReporting obesity now includes causation as due to:
Excess calories
Hypoventilation
Drug induced (make sure you also note what drug)
Need to use additional code (Z68-) to identify the BMI
Important Note: BMI must be diagnosed by the provider, and cannot be calculated by the coder or other office staff. If it is not diagnosed the staff can query the physician to clarify if the provider would like to addendum note with BMI diagnosis.
At NPS, we are committed to providing resources and solutions that deliver economic growth, practice stability and operational efficiencies to our physician partners. NPS offers coding review services to help guide your practice in accurate coding. Click here to learn more about our coding review or feel free to email or call us to speak directly to a member of the NPS team.
This guide is provided for informational purposes only, not as advice for your specific practice, and it should not be solely relied upon for appropriate coding.