Hi,
Someone in our facility is instructed use 250.40, 583.81, 403.90 and 585.x for the scenario. But when seeing the following coding clinic I came to the conclusion that we dont need to add 583.81 for the scenario. see the coding clinic below.
Renal failure due to diabetic nephropathy in patient w/hypertension
Coding Clinic, First Quarter 2003 Page: 20 to 21
Effective with discharges: April 30, 2003
Question:
What is the appropriate coding of chronic renal failure (CRF) due to diabetic nephropathy when the patient also has a diagnosis of hypertension?
Answer:
Assign code 250.40, Diabetes with renal manifestations, type II [non-insulin dependent type] [NIDDM type] [adult-onset type] or unspecified type, not stated as uncontrolled, and code 403.91, Hypertensive renal disease, with renal failure, for diabetic nephropathy with chronic renal failure and hypertension. Diabetes mellitus is one of several disease categories in ICD-9-CM where one code classifies both the disease and its manifestations. Additional codes may be assigned to further describe the manifestations. The following diagnoses: diabetic renal failure, diabetic uremia, diabetic intercapillary glomerulosclerosis and chronic renal failure, diabetic nephropathy with chronic renal failure, or diabetic nephrosis with chronic renal failure provide a cause-and-effect relationship, requiring that code 250.4X, Diabetes with renal manifestations, be sequenced first.
ICD-9-CM assumes a cause-and-effect relationship and classifies chronic renal failure with hypertension as hypertensive renal disease. At category 403, the note reads "any condition classifiable to 585, 586, 587 with any condition classifiable to 401." This wording indicates that the linkage is so compelling when both conditions are present (hypertension and chronic or unspecified renal failure) that hypertensive renal disease is coded. Therefore, if the physician has not indicated "CRF not due to hypertension," code 403.91, Hypertensive renal disease, unspecified, with renal failure, would be assigned.
Thara L CPC H
diagnosis codes, diagnosis coding