Home Health ICD-9/ICD-10 Alert
403.xx: Base Fifth Digit for Hypertensive Kidney Disease on Stage
Question: How should we code for a patient with renal sclerosis due to hypertension? Massachusetts subscriber Answer: Not only does ICD-9-CM assume a relationship between hypertension and kidney disease, but this patient's documented diagnosis also indicates the link, so you'll code for this patient with a 403.xx (Hypertensive chronic kidney disease) code. New instruction from the American Hospital Association's Coding Clinic for ICD-9, Fourth Quarter 2010 offers clarification on how to select a fifth digit for this patient. You'll assign 403.90 (Hypertensive chronic kidney disease; unspecified; with chronic kidney disease stage I through stage IV, or unspecified). "0" is the appropriate fifth digit because "there is no chronic kidney disease stage specified." Remember to also list 587 (Renal sclerosis, unspecified). In a related question, Coding Clinic addresses how to report a patient with renal sclerosis due to hypertension and stage V chronic kidney disease. For this patient, you would list 403.91 (Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease), 587, and 585.5 (Chronic kidney disease, stage V). Choose the fifth digit for subcategory 403.9x based on the patient's CKD stage, in this case 403.91.
Home Health ICD-9/ICD-10 Alert
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