ED Coding and Reimbursement Alert

Question: I heard that there have been some ICD-9 coding changes  for chronic kidney disease (CKD). Is this true, and if so, how should we represent a CKD diagnosis on a claim?


Kentucky Subscriber

Answer: Yes, it's true that CMS revamped the CKD diagnosis coding section. From now on, if you treat a patient who has had CKD, use a code from the 585.1-585.5 series, which describe the disease in five stages.
 
Quick tip: The 585 category's fourth digits simply specify in chronological order the five CKD stages from least severity (stage I) to greatest (stage V). So, if the medical notes say the patient has stage III CKD, you would list code 585.3.

Here are the CKD diagnosis codes that CMS wants you to use in 2006:

- 585.1--Chronic kidney disease, stage I. Use this code for patients who have kidney damage with normal or increased glomerular filtration rate (GFR), greater than or equal to 90 ml/min/1.73m.

- 585.2--... stage II (mild). This code represents kidney damage with mild decrease in GFR, 60-89 ml/min/1.73m.

- 585.3--... stage III (moderate). List this code when the patient has a moderate decrease in GFR, 30-59 ml/min/1.73m.

- 585.4--... stage IV (severe). In this case, there has been a severe decrease in GFR, 15-29 ml/min/1.73m.

- 585.5--... stage V. You-ll need this code for two conditions: kidney damage with GFR of less than 15 ml/min/1.73m, or kidney failure with GFR less than 15 ml/min/1.73m (if the patient isn't on dialysis).

CMS also introduced a new end-stage renal disease (ESRD) code and an unspecified CKD code in 2006. On your claims:

- report 585.6 (End-stage renal disease) if the patient has stage V kidney disease and is on dialysis.

- report 585.9 (Chronic kidney disease, unspecified) to represent chronic renal insufficiency and chronic renal failure NOS (not otherwise specified).