Wiki CKD stage reporting

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amexnikki23

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Hi, the provders I'm auditing encounters for have voiced that they do not have to report the stage of CKD with every single encounter for a patient who has DM w/CKD , or hypertensive CKD. I was under impression we have to follow guidelines for additional code usage as per the ICD-9, but the claims do not get denied, and I cannot find any documentation out there stating that this is a requirement, so when I query the provider to add the CKD stage to their code selections, I get static. any thoughts on this???
 
These codes do require a code for the stage. Look in your code book and you will see a use additional code note. In addition check the guideline for each section and the guidelines instruct to add the additional codes. If the stage is not documented then you will need to use the 585.9 for the stage.
 
For reporting purposes, they SHOULD always report the patients current condition in order for you to accurately report the highest level of specifity with each encounter submitted. Which we are required to do per guidelines.

They are right in that they only have to report the "accurate" condition once a year for higher reimbursement if they see MRA or CRA patients.

Accurate reporting of a patients condition goes further than reimbursement alone and in todays changing payment methodologies, HEDIS and the star rating system, accurate information should be reported on every encounter.

AHIMA says it best...

The absence of complete documentation in patient medical records can have a negative effect on statistical databases, financial planning, clinical preparedness, and gross revenue for the healthcare organization. It is for this reason that every healthcare organization should be focused on ensuring accuracy and completeness in clinical documentation, at any cost.

Link to this information: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok3_005531.hcsp?dDocName=bok3_005531

Good luck!
 
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