Home Health & Hospice Week

Your case-mix depends on it.

If you think your staff can rest easy this year when it comes to diagnosis coding for kidney disease, think again.

While it's true that the Oct. 1, 2005 ICD-9-CM update did introduce changes to the hypertensive kidney disease (403.xx) and hypertensive heart and kidney disease categories (404.xx), there's more in store with this year's update.

New focus: The latest alterations will correct a discrepancy from changes made in the Oct. 1, 2005 ICD-9-CM update.

Starting Oct. 1, 2006 the revised codes will allow you to be more specific when reporting hypertensive kidney disease.

Background: Changes were made last year to the titles for the fifth digits of categories 403 and 404, but the new fifth digit 0 (Without chronic kidney disease) raised a problem, according to the Sept. 30, 2005 ICD-9-CM Coordination and Maintenance Committee meeting diagnosis agenda.

It isn't possible to have hypertensive kidney disease or hypertensive heart and kidney disease without having chronic kidney disease, the committee noted. As a result, the Committee instructed coders not to use '0' in the fifth digit because it is invalid as it currently reads.

Previously, the fifth digits for categories 403.xx and 404.xx indicated whether the patient had chronic renal failure. To synch up with changes made to category 585.x (Chronic kidney disease), which specifies the stage of chronic kidney disease, the fifth digits for categories 403.xx and 404.xx need to distinguish between the less severe stages of chronic kidney disease, and severe kidney disease and end stage renal disease, the committee concluded.

For example, with the newly revised titles for code 403.xx, coders can use fifth digit 0 to indicate patients with chronic kidney disease stage I through stage IV, or unspecified, says Judy Adams of LarsonAllen in Chapel Hill, NC. The fifth digit 1 indicates patients with chronic kidney disease stage V or end stage renal disease, she says.

Don't forget: Coders will still need to use an additional code from subcategory 585.1-585.9 to show the patient's specific stage of chronic kidney disease, reminds Adams.

The American Health Information Management Association (AHIMA) suggested dropping the fifth digit for categories 403.xx and 404.xx because coders will be required to code the stage of the chronic kidney disease anyway with the appropriate 585.x code.

Putting the information in the fifth digit of 403.xx and 404.xx is redundant, AHIMA said. Apparently the Coordination and Maintenance Committee disagreed with this stance because the codes are listed in the recently published tabular addenda as they were originally proposed.

The titles for both categories have also been changed. Code 403.xx now reads "Hypertensive chronic kidney disease" and 404.xx is "Hypertensive heart and chronic kidney disease." Category 585 will include an instruction to list the 403 code first.

ICD-9-CM assumes that hypertension and chronic kidney disease are related, says Lisa Selman-Holman, consultant and principal of Selman-Holman & Associates in Denton, TX. Code for the hypertension first with a code from the 403.xx category and follow this with the appropriate code for the stage of chronic kidney disease, she says.

For example: If your documentation indicates a patient with benign hypertension and stage III chronic kidney disease, you would report:

• 403.10 (Hypertensive chronic kidney disease; benign; with chronic kidney disease stage I through stage IV, or unspecified); and

• 585.3 (Chronic kidney disease, Stage III [moderate]).