Inpatient Facility Coding & Compliance Alert

Remember to use an additional code to specify underlying disorder.

ICD-10 codes for pregnancy-based renal pathology will now be based on the presenting trimester and also require mention of the additional diagnosis. Read on for more instruction on using these.

Background: With the metabolic upheaval the body undergoes in the third trimester, it is not unusual for it to fall prey to alterations in acid-based, electrolyte, and renal function due to pregnancy-associated physiologic changes in renal and systemic hemodynamics. The most typical conditions to present are albuminuria, nephropathy, uremia, and gestational proteinuria.

ICD-9-CM codes: Currently, you do not have much of a choice in coding the renal pathologies associated with pregnancy and delivery. Code 646.2 just denotes all of them under the umbrella of “Unspecified renal disease in pregnancy.” Your specific code choices are:

• 646.20, Unspecified renal disease in pregnancy without mention of hypertension unspecified as to episode of care
  
• 646.21, Unspecified renal disease in pregnancy without mention of hypertension with delivery
  
• 646.22, Unspecified renal disease in pregnancy without mention of hypertension with delivery with postpartum complication
  
• 646.24, Unspecified postpartum renal disease without mention of hypertension.
  

ICD-10-CM change: This will change with the advent of ICD-10 scheduled for October 2015. You’ll have four codes specifying renal disease during pregnancy 

• O26.831, Pregnancy related renal disease, first trimester
  
• O26.832, Pregnancy related renal disease, second trimester
  
• O26.833, Pregnancy related renal disease, third trimester
  
• O26.839, Pregnancy related renal disease, unspecified trimester.
  

So, prepare to report your pregnancy related renal disease based on the first, second, third, or unspecified trimester. You will have to base these on the episode of care, as in delivery or delivery with postpartum complication.

Document the Additional Diagnosis In ICD-10

When studying the ICD-10 codes, you’ll see a note beneath O26.83 (Pregnancy related renal disease) stating that you need to use an additional code to identify the specific disorder. For instance, the patient may have a form of renal disease that is caused by lupus, so you would report M32.14 (Glomerular disease in systemic lupus erythematosus) as your secondary diagnosis. 

You do need to report the specific disorder, but you will look to these codes when your provider documents any of the following conditions and there is no evidence of hypertension:

• Albuminuria in pregnancy or the puerperium
• Nephropathy NOS in pregnancy or the puerperium
• Renal disease NOS in pregnancy or the puerperium
• Uremia in pregnancy or the puerperium
• Gestational proteinuria in pregnancy or the puerperium.

Here’s how to locate these codes in the Alphabetic Index:

Nephropathy (see also Nephritis) N28.9

- Pregnancy-related O26.83-

Pregnancy (single) (uterine)—see also Delivery and Puerperal

- Complicated by (care of) (management affected by)
         - - Glomerular diseases (conditions in N00-N07) O26.83-
         - - nephropathy NEC O26.83-
         - - renal disease or failure NEC O26.83-