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The code book takes the coder to 250.4x for diabetic nephropathy and 583.81 for the manifestation. If the note states CKD, it's coded to 250.4x and 585.x. What if the note states DM with mild renal insufficiency? Would this code to 250.0x or 250.9x, and the 593.9. I don't think we can code this to the 250.4x and 593.9, since mild renal insufficiency is not a chronic kidney disease, necessarily. The provider does link the DM to the RI.... Any thoughts?
250.4X is the code for DM II with RENAL manifestations. Therefore, if the doctor documents the patient as having DM II with mild renal insufficiency, it would code to 250.4X and the code for the renal manifestion, whatever the renal manifestation may be.
I just go by the index in the I-9 book and I don't see anything regarding 'renal manifestations.' Indexing Diabetes, diabetic:
renal (true) 271.4
nephropathy 250.4x {583.81}
nephrosis (syndrome) 250.4x {581.81}
There is nothing to indicate that DM with mild renal insufficiency would code to the 250.4x series. It's a 'given' that when the provider 'links' the DM to the CKD, it's coded to 250.4x and 585.x, but can't find any guidance on using 250.4x with mild renal insufficiency. However; your reasoning is the most logical over using 250.9x, since we 'do' have the linkage of the DM with RI. I will use the 250.4x and go from there.