Urology Coding Alert

If your physician treats cases of chronic kidney disease (CKD), you must be aware of the extensive reporting rules in the ICD-10-CM Official Guidelines for Coding and Reporting. For example, do you know what to do if your physician documents that a patient has hypertensive CKD?

Ask yourself the following questions to make sure you always submit clean CKD claims in your urology practice.

Focus on Special Coding Notes

Question 1: Are there any special coding notes for category N18- (Chronic kidney disease (CKD))?

Answer: Yes. When you report a code from category N18-, you should first code any associated diabetic CKD (E08.22, E09.22, E10.22, E13.22) and hypertensive CKD (I12-, I13-), according to the guidelines.

You should also report an additional code to identify the patient’s kidney transplant status (Z94.0), if applicable.

Break Down Different CKD Stages

Question 2: What are the different stages for CKD, and which ICD-10-CM code choices do I have?

Answer: ICD-10-CM classifies CKD based upon severity of the CKD, which is designated by stages 1-5, according to the guidelines. The stages and codes for CKD are as following:

• Stage 1: N18.1 (Chronic kidney disease, stage 1)
• Stage 2: N18.2 (Chronic kidney disease, stage 2 (mild))
• Stage 3: N18.3- (Chronic kidney disease, stage 3 (moderate)). This category includes codes N18.30 (Chronic kidney disease, stage 3 unspecified), N18.31 (Chronic kidney disease, stage 3a), and N18.32 (Chronic kidney disease, stage 3b).
• Stage 4: N18.4 (Chronic kidney disease, stage 4 (severe))
• Stage 5: N18.5 (Chronic kidney disease, stage 5)

Don’t miss: Stages 3a and 3b are based on a patient’s estimated glomerular filtration rates (eGFRs):

• 3a — eGFR between 45 and 59 mL/minute
• 3b — eGFR between 30 and 44 mL/minute

Keep in mind that the documentation does not need to identify stage 3a or 3b for you to report N18.31 or N18.32. So long as you have documentation in the patient’s chart of the documented eGFR, you may code to the respective CKD substage.

Report ESRD With N18.6

Question 3: Which code should I report for end stage renal disease (ESRD)?

Answer: You should report N18.6 (End stage renal disease) for ESRD when your physician documents ESRD. Code N18.6 includes CKD requiring chronic dialysis.

Don’t miss: A coding note under N18.6 directs you to report an additional code to identify the dialysis status (Z99.2).

Caution: If your physician documents both ESRD and a stage of CKD, you should report code N18.6 only, according to the guidelines.

Handle CKD and Patient’s Kidney Transplant Status With Ease

Question 4: How should I handle a situation where a patient who has undergone a kidney transplant may still have some form of CKD?

Answer: Per the guidelines, a patient who has undergone a kidney transplant may still have some form of CKD because the kidney transplant may not have fully restored the kidney function. “Therefore, the presence of CKD alone does not constitute a transplant complication.” In this case, you should report the appropriate code from category N18- code for the patient’s CKD, as well as code Z94.0 to identify the patient’s kidney transplant status.

Kidney transplant complications: The guidelines also advise you on how to report transplant complications like a failure or rejection. You should report the appropriate code from category T86.1- (Complications of kidney transplant) if your physician documents complications of a kidney transplant.

Caution: You should not report code T86.1- for post-kidney transplant patients who have CKD unless the physician documents a transplant complication. If the medical documentation is unclear as to whether the patient has a complication of the transplant, you should query your physician.

Turn to Hypertensive CKD Advice

Question 5: My physician documented that a patient has hypertensive CKD. How should I handle this situation?

Answer: It is common that a patient with CKD may also have another serious illness such as hypertension. If your physician diagnoses the patient with both hypertension and a condition that falls under category N18- (Chronic kidney disease (CKD)), you should report the appropriate code from category I12- (Hypertensive chronic kidney disease), per the guidelines.

Remember: However, you should not report the CKD as hypertensive if the physician documents that the CKD is not related to the hypertension, according to the guidelines.

Additionally, you should report the appropriate code from category N18- as a secondary code to the appropriate code from category I12- to indicate which stage of CKD the patient has. If the patient has acute renal failure along with the hypertensive CKD, you must also report the appropriate code for the acute renal failure.

Coding example: The patient has hypertensive CKD with stage 2 CKD. The physician does not document that the conditions are unrelated in the medical record. On your claim, you should report codes I12.9 (Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease) and N18.2 (Chronic kidney disease, stage 2 (mild)), in that order.