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Urology Coding Alert


Aim for More Than 'Unspecified' Diagnosis for Chronic Kidney Disease

You need to know the stage of disease for the most accurate coding.

According to the Centers for Disease Control and Prevention, one in ten American adults has some level of chronic kidney disease, or CKD. That prevalence means your physician frequently sees patients who have CKD – and you need to know how to assign the correct diagnosis.

Many patients might start with a diagnosis of unspecified chronic kidney disease. When you still coded with ICD-9, you would report diagnosis 585.9 (Chronic kidney disease, unspecified) for these cases. The code encompassed several conditions, including chronic renal disease, chronic renal failure not otherwise specified, NOS, chronic renal insufficiency, and chronic uremia.

Current options: Now that you use ICD-10, you should file N18.9 (Chronic kidney disease, unspecified). As with ICD-9, this includes conditions that the physician might document as chronic renal failure NOS, chronic renal insufficiency, or chronic uremia.

Coding tips: If you must report N18.9, you should first code any associated diabetic kidney disease (E08.22, E09.22, E10.22, E11.22, or E13.22) or hypertensive chronic kidney disease (I12.~ or I13.~). Also include diagnosis Z94.0 to identify kidney transplant status, if applicable.

However, with the new 2015 diagnostic code set do not use “unspecified” diagnostic codes whenever possible. Instead of the unspecfied code N18.9 for CKD, use the following specific ICD-10 codes:

  • N18.1 – Chronic kidney disease, stage 1
  • N18.2 – Chronic kidney disease, stage 2 (mild)
  • N18.3 – Chronic kidney disease, stage 3 (moderate)
  • N18.4 – Chronic kidney disease, stage 4 (severe)
  • N18.5 – Chronic kidney disease, stage 5
  • N18.6 – End stage renal disease.

Coding guidelines instruct you to use an additional code to identify the dialysis status (Z99.2, Dependence on renal dialysis). Associated terms include hemodialysis status, peritoneal dialysis status, presence of arteriovenous shunt for dialysis, and renal dialysis status NOS. 

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