# Please help!!!! DDM,HTN & CKD?????



## nneecole (Aug 3, 2016)

When patients have DDM, HTN and CKD do you assign DDM with CKD, E11.22, N18.3 and hypertensive chronic kidney disease, I12.9, N18.3? 
I know people will say to ask the doctor. But I work in family practice and many of the doctors don't know which came first. The chicken or the egg. ICD10 says to assume the relationship between the CKD and HTN also the CKD with DDM. So I am confused. I appreciate any imput. I have researched the crap out of this and I can not find the answer. Thank you!


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## danskangel313 (Aug 14, 2016)

It's 100% impossible as the CPT guidelines completely contradict each other. 

Using your example: 
If you have HTN and CKD, you _HAVE_ to code I12.9. And the guidelines for that state you then _HAVE _to use a code from N18.1-N18.4, N18.9 to identify the stage _secondary_. I12.9, N18.3. 

However, the guidelines for the series N18 state you _HAVE_ to code first the DDM (etiology), making the CKD a manifestation, subsequently requiring you to code E11.22 first and N18.3 second for etiology/manifestation, plus Z79.4 for insulin status. 

There's just no way to make N18.3 second for both codes. I've read other people have been coding as I12.9, E11.22, N18.3, Z79.4 so the diabetes sequencing is all together and I guess that's been working. I've heard rumors they're changing the guidelines for 2017 to fix this, but who knows.


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## nneecole (Aug 25, 2016)

Thank you sooooooo much for your help. I am going to go with the I12.9, E11.22, N18.3 and Z79.4. I have a CEU class on 9-15-16. It is an update for ICD-10 2017. I am going to ask them this question as well. Thank you!!!!


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