Home Health ICD-9/ICD-10 Alert

Question: How should I code for a patient with diabetic nephropathy with hypertension and chronic kidney disease stage IV? A co-worker tells me that it's not appropriate to code 583.81 (Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere) with chronic kidney disease. How else can I indicate the nephropathy? 


West Virginia Subscriber


Answer: Nephropathy is a not otherwise specified (NOS) code, but you have specific information regarding your patient's kidney disease, so code the chronic kidney disease rather than nephropathy. Nephropathy means "disease of the kidney."

When dealing with diabetic renal disease and also hypertension, you have two different sequencing rules to contend with -- both diabetes and hypertension must be sequenced before the chronic kidney disease, so code as follows:
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• M0230a: 250.40 (Diabetes with renal manifestations; type II or unspecified type, not stated as uncontrolled);

• M0240b: 403.90 (Hypertensive chronic kidney disease; unspecified; with chronic kidney disease stage I through stage IV, or unspecified) and

• M0240c: 585.4 (Chronic kidney disease, Stage IV [severe]).