Wiki hypertension with diabetic nephropathy and CKD

[DCK1973]

A patient presents for renal transplantation due to ESRD. The final diagnosis is listed as "ESRD due to diabetic nephropathy on dialysis, diabetic retinopathy, diabetic peripheral neuropathy and hypertension." The Official Guideline I.C.9.a.2 states "CKD should not be coded as hypertensive if the provider indicates the CKD is not related to the hypertension." The Official guideline A.15 " the word "with" or "in" should be interpreted to mean "associated with" or "due to" when it appears next to code title, the Alphabetic Index (either under main term or subterm), or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated or when other guidelines exists that specifically requires a documented linkage between two conditions."

I have conflicting thoughts from leadership about the above scenario. In the case above, should the hypertension be linked with the diabetic ESRD?

 

[michellepilcher]

Clarify with the provider to confirm their train of thought.

However, I would read that as the ESRD is caused by diabetic nephropathy, requiring dialysis. The patient has diabetic retinopathy, diabetic peripheral neuropathy and hypertension.
Reasoning: diabetic retinopathy, diabetic peripheral neuropathy are not reasons for ESRD.

 

[racheljonestn@yahoo.com]

This is from AHA coding clinic- 3rd quarter 2019- (This may or may not help depending on who you are coding for.)

"
Question:
The patient presented for renal transplantation due to end stage renal disease (ESRD), and the provider’s final diagnostic statement listed, “ESRD due to diabetic nephropathy on dialysis, diabetic retinopathy, diabetic peripheral neuropathy, and hypertension.” The Official Guidelines for Coding and Reporting (I.C.9.a.2.) state, “CKD should not be coded as hypertensive if the provider indicates the CKD is not related to the hypertension.” In this case, since the provider documented ESRD due to diabetic nephropathy, would this statement be sufficient to indicate that the CKD is not related to hypertension?
Answer:
When the patient has diabetes, hypertension and chronic kidney disease (CKD) and the provider documents CKD due to diabetes or diabetic CKD, diabetic nephropathy or other similar terminology a causal relationship is indicated, and denotes the CKD is not related to the hypertension. In this case, assign a code for diabetic chronic kidney disease. Do not assign a code for hypertensive CKD, as the hypertension would be coded separately.
In addition, it would be redundant to assign codes for both diabetic nephropathy (E11.21) and diabetic chronic kidney disease (E11.22) as diabetic chronic kidney disease is a more specific condition."