Home Health ICD-9/ICD-10 Alert

Question: What codes would I list for a patient with benign hypertensive chronic kidney disease with end stage renal disease (ESRD)? How should my coding differ for a patient with benign hypertensive heart disease with congestive heart failure?

Answer: If the patient has both hypertension and chronic kidney disease (CKD), you may assume that he has hypertensive chronic kidney disease and code his hypertension from category 403.x (Hypertensive chronic kidney disease) and not 401.x (Essential hypertension).

Following the instructions in the coding manual, you would choose 403.11 (Hypertensive chronic kidney disease; benign; with chronic kidney disease stage V or end stage renal disease) for benign hypertensive chronic kidney disease with end stage renal disease. The instructions in the fifth-digit box indicate that you must list an additional code to identify the stage of the CKD, so you should also list 585.6 (End stage renal disease) to indicate the ESRD.

The manual indicates that you should list the 403 code first in both the "Use additional code" instruction at 403 and in the instruction "Code first hypertensive chronic kidney disease, if applicable" seen in the 585 category.

While you can assume the relationship between hypertension and CKD, you cannot assume a relationship between hypertension and heart disease/failure. You need physician documentation to establish this link. If the physician's documentation does state that the patient has hypertensive heart failure or heart failure due to hypertension, then you can code the hypertension from the 402 category.

List 402.11 (Hypertensive heart failure; benign; with heart failure) first, followed by the code for the heart failure, 428.0 (Congestive heart failure, unspecified). The coding manual provides the instructions for sequencing with the "use additional code to specify heart failure..." instruction at 402 and the "Code, if applicable, heart failure due to hypertension first..." at the 428 category.