# dx codes -  partb news coding



## alices (Feb 9, 2012)

Hi I am kind of confused (again) but how would you code htn, ckd and dm, I go through my book and my 3m encoder and I come up with 40390 5859 25000 yet I have seen quite a few coders and just now on partb news coding it 4019 5859 and 25000 so can someone please tell me what I am missing..I know now that that is one of the things I missed on my CEDC exam ( I did pass) but that is the way I have always coded it so if I am coding it wrong I would really like to know...thanks alice


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## mitchellde (Feb 9, 2012)

Is it stated just that way?  nothing to link the diabetes to the ckd?  nothing regarding insulin dependence?  just listed this way as the patient has htn ckd and dm I am agreeing with you. The ckd is ALWAYS linked to the htn per ICD-9 conventions.  The dm would need to be linked by physician statement.  I would ask for a redetermination of this question if that was check as a wrong answer with no more information provided.  Where did you see this on partb news?  do you need a member number to play?


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## hewitt (Feb 9, 2012)

You have chosen three difficult systemic issues to unravel. There are coding guidelines for each that can get pretty intricate. From my perspective, three items that are crucial to follow when coding CKD, HTN, DM: Pathophysiology (identify what other systems are affected, if any), Physician notes, and the notes in the ICD-9 Book. Coding software often does not give enough coding help. I cannot go over all the scenarios, but in general, DMII, 250.00; CKD/CRI 585.9; HTN 401.9. Use these ONLY if there is no other specific detail explaining the cause/pathophysiology or stage. When additional detail is provided in the medical note, that will change everything. You will then have to patiently connect all the detail. Then the other codes, 403.xx, might apply. Alice if you want to discuss this further, please feel free to email me I will be happy to review specific examples with you.


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## mitchellde (Feb 9, 2012)

Coding guidelines state that there is an automatic correlation between CKD and HTN if both are mentioned even without the physician documenting this relationship and we are to automatically code this as 403.9x with the 585.x code.  However with DM the provider must link the condition as being causal to the diabetes before we can code it as a complication, therefore stated as nothing more than the patient has DM, HTN, and CKD according to coding guidelines, which are HIPAA mandated to be followed, we will code 403.9x 585.x and 250.00


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## hewitt (Feb 9, 2012)

I agree with you, Debra, but Alice has not given any specific examples or posted a medical note. General coding guidelines should always be followed. There may be other issues to consider.


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## mitchellde (Feb 9, 2012)

She stated this was an exam question so there will be no medical note, so all things being equal we have no choice but to follow coding guidelines.  However even with the medical note we still must follow coding guidelines, which will not change the choice of the 403.xx code.


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## alices (Feb 10, 2012)

*re-dxs*

this is what there note says, sorry for the length..
cc follow-up chronic conditions and meds, HPI established 68 year old female wants back on byetta, the victoza causes gas and she doesn;t want to take it, she has an appointment to see nephrology 6/4/10 
 exam: wt 196, bp 135/83, p 95, t98 rbs 211, (there is more but nothing stating the ckd is due to dm or htn)
assesment: dm, ckd, htn, med mangmnt, hyperlipidemia. plan return for labs, followup in 3 months.
Now i took this off of partb news discussion forum but question was on the CEMC code a rounds from the AAPC and there answer was 25000, 5859, 4019, and 2724..
 so I really don't know what to think on this, like I said earlier I have always coded the htn and ckd as 40390 and 5859 unless of course it is stated that the cause was the dm..
thank you everyone for all the help.. 
I sometimes (alot lately) start thinking I don't really know what I am doing, I use to be so confident and now I don't know and not only because of this issue but of others as well in the coding of dx's so thanks again for any and all help it is really appreciated..alice


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## kissie (Feb 10, 2012)

Alice, you're initial instinct is correct. It is all stated in the ICD-9 guidelines to connect HTN and CKD.


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## mitchellde (Feb 11, 2012)

Yes you are correct I believe you can challenge the code around answers. I would contact someone at aapc on this if i were you.


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## alices (Feb 13, 2012)

*re-dxs*

thank you so much for all the help, I thought I was right but I just wanted to be sure..thanks again and have a great day..alice


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