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Renal failure coding tips

HIM Connection, January 12, 2010

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• Don’t discount nonessential modifiers. In the absence of a specific stage of CKD, coders can use nonessential modifiers (i.e., “mild,” “moderate,” or “severe”) to stage the disease when these modifiers are documented, says Jennifer Avery, CCS, CPC-H, CPC, CPC-I, senior regulatory specialist at HCPro, Inc., in Marblehead, MA.
• Pay close attention to transplant patients. The presence of CKD alone in a patient who has undergone a kidney transplant is not a transplant complication, says Avery. When the physician does not document a complication, assign a code for the stage of CKD and code V42.0 (transplant status). When a complication such as failure or rejection is documented, report 996.81 (complications of transplanted kidney). Query the physician when documentation is unclear.
• Don’t make assumptions. Unless the physician documents a link between CKD and another condition, coders may not assume a cause-and-effect relationship exists, says Robert S. Gold, MD, founder and CEO of DCBA, Inc., in Atlanta. This comes into play with CKD as it relates to anemia (285.21), hyperparathyroidism (588.81), diabetes (code category 250.xx), and secondary diabetes (code category 249.xx). The only exception concerns hypertension and CKD. ICD-9-CM presumes a cause-and-effect relationship between the two and classifies the diagnosis as hypertensive CKD (code category 403) or hypertensive heart disease (code category 404).

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