Home Health ICD-9/ICD-10 Alert

Question: Our patient has type I diabetes. He is on insulin and has diabetic chronic kidney disease (CKD) and hypertension (HTN). He was referred to our agency for aftercare following a kidney transplant for end stage renal disease. The physician states that the patient still has stage 3 CKD. How should we code for him?

Louisiana Subscriber

Answer: Code for this patient as follows, says Sharon Molinari, RN, HCS-D, COS-C, a home health consultant based in Henderson, Nev.:

• M1020a: V58.44 (Aftercare following organ transplant);
• M1022b: 250.41 (Diabetes with renal manifestations; type 1 [juvenile type], not stated as uncontrolled);
• M1022c: 403.90 (Hypertensive chronic kidney disease; unspecified with chronic kidney disease stage I through stage IV, or unspecified);
• M1022d: 585.3 (Chronic kidney disease, stage III [moderate]); and
• M1022e: V42.0 (Organ or tissue replaced by transplant; kidney).

Your focus of care is aftercare following your patient’s kidney transplant, so V58.44 is your principal diagnosis. An instructional note following this code in the Tabular List of your ICD-9 coding manual instructs you to list an additional code to identify the organ transplanted. In this case, you’ll list V42.0 to indicate that the patient had a kidney transplant. You can sequence this code at the end of your list, because there is no requirement for it to immediately follow the aftercare code.

Next, you’ll need to report your patient’s diabetic chronic kidney disease and hypertension. You’ll list three codes to convey these diagnoses. First, report 250.41 to indicate that your patient has type 1 diabetes with renal manifestations. Next, you’ll need to indicate patient’s diabetic manifestation — hypertensive CKD. Remember, you can assume that the patient’s chronic kidney disease is hypertensive when he has both conditions. List 403.90, followed by 585.3 to indicate the stage of his chronic kidney disease. Instructional notes in the Tabular List will help guide your sequencing for this patient.

In ICD-10, you would report

• M1021a: Z48.22 (Encounter for aftercare following kidney transplant);
• M1023b: E10.22 (Type 1 diabetes mellitus with diabetic chronic kidney disease);
• M1023b: I12.9 (Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease); and
• M1023b: N18.3 (Chronic kidney disease, stage 3 [moderate]).

In ICD-10, one code (Z48.22) specifies that you are providing aftercare following your patient’s kidney transplant.

You’ll need three codes to describe the patient’s diabetic chronic kidney disease and hypertension, but take note that you no longer need to indicate whether his hypertension is malignant, benign, or unspecified.