Practice Management Alert

Capture Deserved Pay For CKD With New ICD-9 Codes

While medical offices are trying to get used to new and revised CPT codes for 2006, they should also pay attention to the changes in diagnosis coding for this year -quot; especially for patients with chronic kidney disease (CKD).

Reason? Offices that treat CKD patients need to know the ICD-9 codes from the 585.1-585.5 series, which describe the disease in five clear stages. Further, there are two other ICD-9 codes in the 585.x  series to represent CKD. This is good news for billers who want the most accurate diagnosis coding possible.

-The expanded CKD classification allows the coder and the physician to paint a clearer picture of the patient's condition and, in turn, may justify the appropriate course of treatment,- says Tara Conklin, CPC, an independent coding consultant in Wesley Chapel, Fla.

Quick tip: The 585 category's fourth digits simply specify in chronological order the five CKD stages from least severity (stage I) to greatest (stage V). The new CKD codes are:

- 585.1 (Chronic kidney dis- ease, stage I). Use this code for patients who have kidney damage with normal or increased glomerular filtration rate (GFR), greater than or equal to 90 ml/min/1.73m.

- 585.2 (... stage II [mild]). This code represents kidney damage with mild decrease in GFR, 60-89 ml/min/1.73m.

- 585.3 (... stage III [moderate]). List this code when the patient has a moderate decrease in GFR, 30-59 ml/min/1.73m.

- 585.4 (... stage IV [severe]). In this case, there has been a severe decrease in GFR, 15-29 ml/min/1.73m.

- 585.5 (... stage V). You-ll need this code for two conditions: kidney damage with GFR of less than 15 ml/min/1.73m, or kidney failure with GFR less than 15 ml/min/1.73m (the patient isn't on dialysis).

 In addition to the five diagnosis codes for each stage of CKD, two new ICD-9 codes have been added to the section:

- 585.6 (End-stage renal disease). Report this code if the patient has stage V kidney disease and is on dialysis.

- 585.9 (Chronic kidney disease, unspecified). Use this code for chronic renal insufficiency and chronic renal failure NOS (not otherwise specified).

Quick example: If the medical notes indicate that a patient has stage III CKD, you would list code 585.3 on the claim to represent the condition.