Wiki DM with CRI( chronic renal insufficiency)

[wisibyusha]

Hello,

Do we assume linkage between DM and Chronic renal insufficiency if the provider just states under the Assessment 1. DM
2. Chronic renal insufficiency

renal insufficiency indexes to N28.9
CRI indexes to N18.9 same as CKD so can a coder assume linkage between DM and Chronic renal insufficiency?
Thank you

 

[TThivierge]

Hi Wisibyusha,
This is fine way coded it. But provider should tell you what level of CKD. There are 6 stages N18.1-N18.6. I d code it as dx E11.22 and N28.9 and no Excludes 1 rule with this but detailed & match provider assessment. But did the patient get insulin dx Z79.4 or using kidney dialysis dx Z99.2? If in documentation these dx codes should be added too.
Take care and hope helped you.
Lady T

 

[wisibyusha]

Hi Wisibyusha,
This is fine way coded it. But provider should tell you what level of CKD. There are 6 stages N18.1-N18.6. I d code it as dx E11.22 and N28.9 and no Excludes 1 rule with this but detailed & match provider assessment. But did the patient get insulin dx Z79.4 or using kidney dialysis dx Z99.2? If in documentation these dx codes should be added too.
Take care and hope helped you.
Lady T

Thank you so much! the linkage is the one I wanted to make sure. Yeah, I coded the stage and since the linkage trumps the Z79.4 HCC I don't need to capture the insulin. I do Risk adjustment.

 

[cfordCPC]

Yes, always assume linkage unless the provider states otherwise. Chronic renal insufficiency is the same as chronic kidney disease. The dx codes for chronic renal insufficiency AKA chronic kidney disease (CKD) are N18.1 thru N18.6 and N18.9 for CKD unspecified.

Example: If patient has Type 2 diabetes with diabetic chronic kidney disease, you would code E11.22 and code N18.1 - N18.6 to identify stage of disease. If the provider does not specify stage of disease code E11.21 and N18.9. I would query the provider to get the stage though.