June 10, 2022 | By Scott Kraft, CPMA, CPC
I regularly see E11.22 coded, followed by the stage of chronic kidney disease when a patient has diabetes with chronic kidney disease. I’m not sure if I’m unlucky, but I rarely see the same correct diagnosis coding when it comes to hypertension and chronic kidney disease.
Under ICD-10-CM, coders are instructed to assume a cause-and-effect relationship between hypertension and chronic kidney disease and code them together unless the rendering provider’s documentation specifically states they aren’t related. In my experience, such a non-relationship is rarely specifically documented.
As a result, I often find myself changing I10 when it is coded for a patient with chronic kidney disease.
Remember, the correct way to code hypertension with chronic kidney disease is to assign I12.9 for a patient with hypertension and chronic kidney disease stages 1-4 or unspecified chronic kidney disease.
If a patient has hypertension and stage 4 chronic kidney disease, the correct coding is to code I12.9, followed by N18.4. When the patient has stage 5 chronic kidney disease, code I12.0, followed by N18.5. If the patient has ESRD, code I12.0 followed by N18.6.
When the patient has both diabetes and hypertension alongside chronic kidney disease, code E11.22, I12.9, or I12.0 for the hypertension and then the stage of chronic kidney disease or end-stage renal disease.
Because these conditions are presumed to be related, when the provider is managing hypertension in the setting of chronic kidney disease, he or she is managing hypertensive chronic kidney disease, and both should be coded.
When the provider’s documentation is not specific enough to the chronic kidney disease, the provider should be educated to document both conditions and the stage of chronic kidney disease when known, with an appropriate plan of care to address the condition.
