The fifth digit, also a 2, indicates the complication is associated with CKD. As previously mentioned, diabetes is responsible for nearly two-thirds of CKD cases. ESRD is reported as 585.6 in ICD-9-CM and N18.6 in ICD-10-CM. ICD-9-CM presumes a cause-and-effect relationship and classifies CKD with hypertension as hypertensive CKD. Fifth digit assignment identifies the stage of the kidney disease. Assign an additional code from category 428-Heart failure, to identify the type of heart failure. The stage is determined by the degree of kidney damage and the Glomerular filtration rate (GFR), an indicator of how well the kidneys are functioning. Additionally, assign a code from category N18 to identify the stage of the CKD.End Stage Renal DiseaseIn the United States, ESRD is an administrative term based on conditions for health care payment by the Medicare ESRD Program for patients treated with dialysis or transplantation due to permanent kidney failure. In ICD-9-CM and ICD-10-CM, the code for ESRD is found in the same category as the codes for CKD. Additional guidance is provided in ICD-10-CM under N18.6 to use additional codes to identify dialysis status (Z99.2). ESRD is reported as 585.6 in ICD-9-CM and N18.6 in ICD-10-CM. ESRD is the most severe form of CKD and should only be assigned when the provider documents ESRD. If a causal relationship is not documented, the heart condition and hypertension are coded separately and sequenced according to the circumstances of the admission/encounter. ICD-10-CM instructs the user to assign codes from category I13-Hypertensive heart and CKD, when both conditions are stated in the diagnosis. Therefore, if a patient has each of these conditions, a code from I13 should be assigned. The code for end stage renal disease (585.6) cannot be assigned without supporting documentation from the provider. When both hypertensive kidney disease and hypertensive heart disease are stated in the diagnosis, ICD-9-CM guidelines require assignment of codes from category 404-Hypertensive heart and CKD. Fifth digit assignment identifies the stage of the kidney disease. Assign codes from category 403-Hypertensive CKD, when conditions classified to category 585-CKD are present with hypertension. Assign an additional code from category 428-Heart failure, to identify the type of heart failure. The fourth digit 2 indicates the underlying condition is a kidney complication. Category I13 represents combination codes that include hypertension, heart disease, and CKD. Under ICD-10-CM, CKD is reported under category N18, with fourth digit assignment indicating the stage of the disease. Under ICD-10-CM, CKD is reported under category N18, with fourth digit assignment indicating the stage of the disease. The first code indicates the presence of both hypertension and CKD; the second code identifies the stage of CKD. A closer look: Documentation and coding for chronic kidney diseaseThis months Blue Review highlights documentation and coding for Chronic Kidney Disease (CKD) under the ICD-9-CM and ICD-10-CM code sets.The National Kidney Foundation defines CKD as a condition characterized by a gradual loss of kidney function over time.1 CKD is classified to category 585Chronic Kidney Disease, in ICD-9-CM. If both a stage of CKD and ESRD are documented, ESRD is the only code that should be assigned per ICD-9-CM and ICD-10-CM guidelines. With hypertensive CKD, ICD-9-CM and ICD-10-CM assumes a relationship between the hypertension and the CKD, whether or not the condition is so designated. The Official ICD-9-CM Guidelines for Coding and Reporting provide guidance related to hypertensive CKD coding. CKD can progress to End Stage Renal Disease (ESRD), which is also reported using a code from the 585 category. To accurately report a diagnosis of hypertensive CKD using diagnosis code 403, it is important to select the appropriate fourth digit to indicate whether the hypertension is classified as malignant (0), benign (1) or unspecified (9). ESRD is the most severe form of CKD and should only be assigned when the provider documents ESRD. CKD stage I-IV, or unspecified, is indicated by a fifth digit assignment of (0), while CKD stage V, or ESRD, is indicated by a fifth digit assignment of (1).The appropriate code from category 585-CKD, should be reported as discussed above, to identify the stage of CKD.Similar to the current ICD-9-CM coding system, ICD-10-CM requires two codes to accurately report a diagnosis of hypertensive CKD. This assumption is the same under ICD-10-CM. Additionally, the appropriate code to identify the stage of the CKD is assigned in both ICD-9-CM and ICD-10-CM.References:1 The National Kidney Foundation About Chronic Kidney Disease Optum ICD-9-CM for Hospitals-Volumes 1, 2 & 3 2014 Professional Optum ICD-10-CM The Complete Official Draft Code Set 2014 Draft KDIGO 2012 Clinical Practice Guidelines for CKD Evaluation and Management, A closer look: Documentation and coding for chronic kidney disease. This assumption is the same under ICD-10-CM. In ICD-9-CM and ICD-10-CM, the code for ESRD is found in the same category as the codes for CKD.When coding CKD in ICD-9-CM or ICD-10-CM, coding guidelines provide instruction to also assign diagnosis codes for any associated conditions. Fourth digit assignment indicates the stage of the disease which is based on severity. The severity is designated by Stages IV. Under the ICD-10-CM coding system, there is no distinction between benign, malignant, or unspecified hypertension as is under the ICD-9-CM code set.Diabetic Chronic Kidney DiseaseFebruarys Blue Review highlighted documentation and coding for diabetes and related diabetic diagnoses. Additional guidance is provided in ICD-10-CM under N18.6 to use additional codes to identify dialysis status (Z99.2).Hypertensive Heart and Chronic Kidney DiseaseWhen both hypertensive kidney disease and hypertensive heart disease are stated in the diagnosis, ICD-9-CM guidelines require assignment of codes from category 404-Hypertensive heart and CKD. To accurately report a diagnosis of hypertensive CKD using diagnosis code 403, it is important to select the appropriate fourth digit to indicate whether the hypertension is classified as malignant (0), benign (1) or unspecified (9). CKD stage I-IV, or unspecified, is indicated by a fifth digit assignment of (0), while CKD stage V, or ESRD, is indicated by a fifth digit assignment of (1). The National Kidney Foundation defines CKD as a condition characterized by a gradual loss of kidney function over time. If both a stage of CKD and ESRD are documented, ESRD is the only code that should be assigned per ICD-9-CM and ICD-10-CM guidelines. Hypertensive Chronic Kidney DiseaseHypertension is one of the leading causes of CKD and, together with diabetes, is responsible for nearly two-thirds of CKD cases. Centers for Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD 21244, MDC 11 Diseases & Disorders of the Kidney & Urinary Tract, Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease, Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease, Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease, Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease, Acute kidney failure with tubular necrosis, Acute kidney failure with acute cortical necrosis, Acute kidney failure with medullary necrosis, Chronic kidney disease, stage 3 (moderate). In ICD-9-CM, when CKD is due to diabetes, it is reported with code 250.4X and the documented stage of CKD is reported with code 585.X. Recall that under category 250 diabetes mellitus, ICD-9-CM requires a fourth digit to identify associated conditions and a fifth-digit to identify the type of diabetes mellitus, and whether the diabetes is controlled or uncontrolled. In the United States, ESRD is an administrative term based on conditions for health care payment by the Medicare ESRD Program for patients treated with dialysis or transplantation due to permanent kidney failure. If a causal relationship is not documented, the heart condition and hypertension are coded separately and sequenced according to the circumstances of the admission/encounter.ICD-10-CM guidelines for reporting hypertensive heart and CKD are very similar to ICD-9-CM. In ICD-9-CM, when CKD is due to diabetes, it is reported with code 250.4X and the documented stage of CKD is reported with code 585.X.Under ICD-10, CKD due to diabetes has a fourth and fifth digit designation. With hypertensive CKD, ICD-9-CM and ICD-10-CM assumes a relationship between the hypertension and the CKD, whether or not the condition is so designated.