# Code first in ICD10 with CKD or ESRD



## ctscharpf (Sep 21, 2015)

ICD10: 

In the coding guidelines for chronic kidney disease it indicates code first for underlying conditions Diabetes and Hypertension. In the CKD stages I-IV most physicians address those underlying conditions in their notes and they are coded correctly.

However, for End Stage renal disease (N18.6) the notes for the dialysis visits rarely assess, evaluate or treat the underlying conditions in their notes. Previously all MCP bills were sent with the ESRD diagnosis and the status code (Z99.2 in ICD10). Are the guidelines different for ESRD than Stages I-V? If they don't document anything regarding the assessment, treatment or plan for the underlying conditions, do they include the diagnosis on their bill?


----------



## rose2014 (Oct 13, 2015)

*reply*

Hi,
Were you able to get any response to the query of yours?

Thanks


----------



## mitchellde (Oct 13, 2015)

If the CKD is due to an underlying disease you need to follow the guidelines even if you are not treating the underlying condition and code it first.  While you are not treating the diabetes you are treating a complication of the diabetes and that is exactly what the code diabetes with chronic kidney disease states (E08.22, E09.22, E10.22, E11.22).


----------



## NHill (Oct 16, 2015)

*Use additional code note for ESRD in ICD 10*

On a similar note if the physician indicates ESRD and the patient is coming to see us for dialysis access (we are a general surgery practice), would we code the Z99.2 for that first visit? Or start using it once dialysis access is achieved.
Thank you in advance for any clarification!
Nancy


----------

