Home Health ICD-9/ICD-10 Alert

Question: How should I code for a patient with principal diagnosis of diabetic nephropathy with diabetic hypertension and chronic kidney disease stage IV?

North Dakota Subscriber

Answer: You can’t assume a relationship between diabetes and kidney disease.

But in your patient’s case the documentation indicates a link, so you can code for the diabetes with fourth digit “4” to indicate the renal manifestation and follow this with the nephropathy code 583.81 (Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere).

On the other hand: If there is no documentation of the relationship, then you’ll have to code for the two conditions separately. In that case, it’s not appropriate to use the fourth digit “4” in the diabetes code. And you’ll need to look elsewhere in the 583 category to find the appropriate nephropathy code.

When your patient has both diabetic renal disease and hypertension, you have two different sequencing rules to contend with — both diabetes and hypertension must be sequenced before the chronic kidney disease. So in your patient’s case, you would code as follows:

• M1020a: 250.40 (Diabetes with renal manifestations; type II or unspecified type, not stated as uncontrolled);
• M1022b: 583.81 (Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere)
• M1022c: 403.90 (Hypertensive chronic kidney disease; unspecified; with chronic kidney disease stage I through stage IV, or unspecified) and
• M1022d: 585.4 (Chronic kidney disease, Stage IV [severe]).