# DMII/CKD/HTN Coding



## jrmca1 (May 18, 2012)

Question.

Clinician documents that patient has DMII with CKDIII and HTN with CKDIII. What would be the correct way to coding this scenario?

Thanks


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## j-fowler57 (May 18, 2012)

I used the Encoder and came up with 250.40 (DM II renal), 4039.90(HTN unspecified renal), 585.3(CRF III) Hope this helps


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## mitchellde (May 18, 2012)

yes that is how it is coded, the word with indicates a causal relationship so if the provider states it exactly that way then the CKD is a manifestation of the diabetes and is always linked to the HTN per ICD conventions.


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## jrmca1 (May 19, 2012)

Thank you Debra!

Do you do hospital coding? If so what type of service do you code?


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## jrmca1 (May 19, 2012)

Thank you J-Fowler57


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## mitchellde (May 19, 2012)

jroman72 said:


> Thank you Debra!
> 
> Do you do hospital coding? If so what type of service do you code?



I code inpatient, outpatient and physician.  I also teach all areas and all specialties in both ICD-9 Cm and CPT also ICD-10 CM.


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## ccosta (Jul 24, 2012)

it has always been my understanding that one must show a cause and effect of diabetes and any manifestation; this is done by using the terminology of "Due to", "Diabetic", or "Etiology of CKD is DM"; utilizing the word "with" does not show this relationship. this information comes from AHA and the coding clinic, is taught in coding classes and is stated the same for ICD-10.
Carl


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## mitchellde (Jul 24, 2012)

ccosta said:


> it has always been my understanding that one must show a cause and effect of diabetes and any manifestation; this is done by using the terminology of "Due to", "Diabetic", or "Etiology of CKD is DM"; utilizing the word "with" does not show this relationship. this information comes from AHA and the coding clinic, is taught in coding classes and is stated the same for ICD-10.
> Carl


The word "with" was redefined in the 2010 coding guidelines and since that time the use of the word with as in CKD with diabetes does indicate a causal relationship.

From the ICD-9 CM Oct 1 2011 coding guidelines page 9:
8. “With”
The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List.
The word “with” in the alphabetic index is sequenced immediately following the main term, not in alphabetical order.

From the ICD-10 CM 2012 coding guidelines:
15. “With”
The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List.
The word “with” in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.

The coding clinics may be prior to this timeframe.


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## ccosta (Jul 25, 2012)

Debra,
I do agree with you that the guideline states the word with should be associated with due to, however that is in reference to the code title, not when it appears in the medical record, which is where I was referring to. 
This seems to be a major disconnect between the providers and the coders, since the wording of the descriptor states "with" and we are asking for "due to" or "diabetic"; the providers' response is, well that is what the code states. 
As far as AHA coding guidelines goes, the only reference I have found is the statement that you can use the casual relationship between DM and Neuropathy even if it isn't stated as due to or diabetic, this is the same casual relationship that is used with CKD and Htn. 
If you know of any other documented statements that clarify this issue I would love to have them, it would make my education and coding staff's work a lot easier.
Thanks,
Carl


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## Cortzea (Feb 24, 2015)

IN my case my Md documents as such: 

"Chronic kidney disease resulted from gradual renal deterioration. The etiology of the disease is thought to be diabetic nephropathy and hypertensive nephropathy"  

what code should i use as primary since the reason of appt was renal f/u


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## kgodda1 (Feb 24, 2015)

Stating DMII with CKDIII is _*not*_ enough to establish a causative relationship between diabetes and CKD.  The documentation you provided would cause me to assign a hypertensive CKD code and an uncomplicated DMII code.  But, I would first suggest you query the physician to make sure.  The physician should be aware his statement was ambiguous...it also provides an excellent opportunity to educate this physician on the importance of complete documentation.   

Quote: "From the ICD-9 CM Oct 1 2011 coding guidelines page 9:
8. With?
The word with? should be interpreted to mean associated with or due ? when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List.
The word with in the alphabetic index is sequenced immediately following the main term, not in alphabetical order.

From the ICD-10 CM 2012 coding guidelines:
15. With
The word with? should be interpreted to mean associated with or due? when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List.
The word with? in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order."

This guideline refers to the use of the index....not a coding guideline.


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## Cortzea (Mar 9, 2015)

I wouldve coded this as such:
403.90 ( since i dont know if the hypertension is benign or malignant),585.3,( the stage of the ckd ),250.40 ( DM is not specific as controlled or uncontrolled ) 

im not sure if i am correct !


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