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HTN with Chronic Kidney Disease-CB

Lina Posted Wed 23rd of December, 2015 12:30:27 PM

Can you tell me when to change plain HTN to HTN with kidney disease. We had a patient with a normal BUN and creatinine and normal microalbumin but GFR was low. Should that qualify for HTN with CKD or should one test have to be abnormal

SuperCoder Answered Thu 24th of December, 2015 05:23:37 AM

In regard to hypertension and CKD; a cause-and-effect relationship is assumed between the two conditions unless otherwise documented by the provider. The provider must specifically state that the CKD and hypertension are not related in order to not use the combination code.
When hypertension and CKD are documented without further specification, a category 403 code is assigned. The fifth digits and instructional notes reflect the stage of CKD and provide the coding professional with “use additional code” notes. For category 403, a fifth digit of 0 represents CKD, stages I through IV, or unspecified. A fifth digit of 1 represents CKD stage V or ESRD. If a code from category 403 is assigned, then an additional code from 585.x is also assigned to identify the stage of CKD

Both ICD-9 and ICD-10 require specifying the stage of the chronic kidney disease to properly code the condition. Very few patients have a true glomerular filtration rate (GFR) measured and most staging relies on the estimated glomerular filtration rate (eGFR). Most laboratory reports provide a race-based reference range. It is not uncommon for these estimates to have slight variability and for the patient's staging to vary between stage 2 and 3. Note that ICD-10 differentiates stage 5 from end-stage renal disease by the need for chronic dialysis.

ICD-10 requires first using an I12 code for the combined diagnosis of hypertension and chronic kidney disease.

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