# Hypertension with CKD



## chrisden_7 (Apr 9, 2010)

Hi everyone,
I code for a Nephrology office with 4 physicians and a Physician Assistant, my question is when I see a primary diagnosis of chronic kidney disease with a secondary dx of hypertension, does that itself give me enough information to make the second diagnosis 403.xx instead of 401.x. I'm not able to find anything that definitively states that this is the correct way to code. I understand that ICD-9 states to assume a cause and effect relationship (pgs. 9-10) but it's hard to wrap my head around an assumption when it was drilled into me from my education that a good coder does not assume anything. I would really appreciate an experienced nephrology coder's advice on this.
Thanks,
Chrisden_7


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## 00029754 (Apr 9, 2010)

*HTN & chronic kidney disease*

"When the diagnostic statement includes both hypertension and chronic kidney disease, ICD-9-CM usualyy assumes there is a cause-and effect relationship." (Faye Brown 2010 p 347) The relationship does not need to be documented by the physician.


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## mitchellde (Apr 9, 2010)

The coding guidelines will tell you this is automatically 403.xx and your CKD 585.x is the secondary code.


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## rthames052006 (Apr 9, 2010)

mitchellde said:


> The coding guidelines will tell you this is automatically 403.xx and your CKD 585.x is the secondary code.



Debra is correct... I remember when I first started billing/coding I never read the coding guidelines in the front of the ICD-9, I was never told/trained to do so until I got connected with the AAPC and decided to actually read the the ICD-9 front from to back- It's amazing what you learn.  Now every year I read thru it to make sure I know what's going on and I highlight things pertinent to what I code and bill for on a daily basis.  

I too had trouble at first understanding why the relationship was assumed but it is drilled into my head now... after all these years....

Just my 2 cents.


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## chrisden_7 (Apr 12, 2010)

Thanks everyone,
It's good to know I'm not alone in my ever evolving training! I am using the 403.XX codes with my 585-587 codes and I'm wading through the front section of my ICD-9 now. Looking forward to the next challenge!


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