Home Health ICD-9/ICD-10 Alert

Question: Our patient has hypertension, stage IV chronic kidney disease, and renal atrophy. How should we code for him?

Pennsylvania subscriber

Answer: List the following codes for this patient:

• M1020a: 403.90 (Hyperactive chronic kidney disease; unspecified; with chronic kidney disease stage I through stage IV, or unspecified) and
• M1022b: 585.4 (Chronic kidney disease, Stage IV [severe]).

When a patient has both hypertension and chronic kidney disease, ICD-9 presumes a link, so you can code for this patient with a hyperactive chronic kidney disease code — 403.90 in your patient’s case. 

You’ll see a “use additional code” note following 403.90 that advises you to list a second code to identify the stage of your patient’s chronic kidney disease. In the scenario you describe, list 585.4. 

In your coding manual, you’ll see notes under the 585.x (Chronic kidney disease [CKD]) category advising you to list an additional code if your patient has had a kidney transplant — not an appropriate code to list in your patient’s case. Your coding manual will also instruct you to list an additional code for manifestations such as neuropathy or pericarditis. There is another note at 585.x that indicates “Code first hypertensive chronic kidney disease, if applicable” meaning the hypertension code. In the scenario you describe, you do not need to list the code for renal atrophy — 587 (Renal sclerosis, unspecified). All conditions classified to 587, including renal atrophy, are included in the 403 code.

In ICD-10 for this patient, you would list the following:

• M1021a: I12.9 (Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease) and
• M1023b: N18.4 (Chronic kidney disease, stage 4 [severe]).

You’ll need at least two codes to describe this patient’s condition in ICD-10, but the new data set also asks you to report your hypertensive patient’s exposure to tobacco smoke. Choose from the following additional codes, if applicable:

• Z77.22 (Contact with and [suspected] exposure to environmental tobacco smoke [acute] [chronic]);
• Z87.891 (Personal history of nicotine dependence);
• F17.- (Nicotine dependence);
• Z72.0 (Tobacco use); and 
• Z57.31 (Occupational exposure to environmental tobacco smoke).

Tip: The ‘use additional code’ instructions are conventions, so you are required to add the additional code, if applicable.