# Hypertension, diabetes and kidney disease



## mstansell (May 2, 2013)

If you have a diabetic patient who is hypertensive, with stage 3 kidney disease, is the assumption still that the kidney disease is related to the hypertension?  If so, would I still bill the diabetes with renal manifestations?


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## mitchellde (May 2, 2013)

it is a presumed relation between the HTN and the renal disease so you must combine those however it must be a documented relationship between the diabetes and the renal disease such as diabetic chronic kidney disease or kidney disease due to diabetes.  without the documented relationship for what you have listed code the diabetes as noncomplicated (4th digit 0) and combine the HTN and the chronic kidney disease.


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## mstansell (May 2, 2013)

*coding relationship*

I knew about the assumed relationship, however I asked my physician and he stated that there is no way to know if the diabetes or the hypertension is the cause of the kidney disease, which is why I asked the question


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## mitchellde (May 2, 2013)

That is why the ICD conventions took the HTN to renal out of your hands it is a presumptive relationship and must be combined, however it is up to the provider to combine the diabetes to the renal and if he does not then we do not.


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## mstansell (May 2, 2013)

so then they are saying it isn't possible for both the hypertension AND the diabetes to have renal complications?!?  Because my physician is saying differently.  Is it a physician who determined the coding conventions?


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## mitchellde (May 2, 2013)

No, it is possible for HTN and Diabetes to both have renal complications, I am saying in your original statement it does not say that.  you stated:
" diabetic patient who is hypertensive, with stage 3 kidney disease"  
this would have to be coded as 250.00 and 403.90, 585.3  because the statement does not indicate that the renal is causal to both the HTN and the diabetes.
and yes the coding guidelines and conventions are written by physicians


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## KaylaR2007 (May 15, 2013)

250.4X can only be used if the diabetes caused the renal complication.  If no link between diabetes and CKD, then it is 250.0x with the complication.


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