Nephrology ICD-10 CM Training. ICD-10-CM will be valid for dates of service on or after October 1,...

Nephrology

ICD-10 CM Training

• ICD-10-CM will be valid for dates of service on or after October 1, 2015– Outpatient dates of service of October 1, 2015 and

beyond. – Inpatient hospital service claims, is effective for dates of

discharge after September 30, 2015

ICD-10-CM Compliance Dates

• Covered Entities– Everyone covered by the Health Insurance Portability

Accountability Act (HIPPA)

• Non-Covered Entities– Worker’s Compensation– Auto Insurance– Non covered HIPAA entities are exempt but are

encouraged to adapt the new code set

Covered and Non-Covered Entities

• 21 Chapters• Alpha-numeric codes; not case-sensitive

– Codes begin with Alpha letter, A-Z, excluding U– Common errors

• I verses 1• O verses 0

• “X” Placeholder• 3 to 7 characters

– Decimal following 3rd character

ICD-10 Code Structure

• Placeholder “X”– Used for future expansion of a code– Fills in empty characters when a 6th and/or 7th character

apply– The placeholder may be used in different scenarios but

should never serve as the final character.

Example: W19.XXXA Unspecified fall, Initial Encounter


• 7th Character– Provides specified information regarding the clinical visit– Is required for certain categories and must be reported in

the seventh position– May be alpha or numeric– Has different meanings depending on the coding category


• Laterality– Some ICD-10-CM codes indicate laterality, specifying

whether the condition occurs on the left, right or is bilateral.

– If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.

– If the side is not identified in the medical record, assign the code for the unspecified side.

OGCR section 1.B.13


• “Other” Codes– Codes titled “other” or “other specified” are for use when

the information in the medical record provides detail for which a specific code does not exist.

• “Unspecified” Codes– Codes titled “unspecified” are for use when the

information in the medical record is insufficient to assign a more specific code.

OGCR section 1.A.9.a.b


• Excludes Notes– Excludes1

• A type 1 Excludes note is a pure excludes note• It means “NOT CODED HERE”• The code excluded should never be used at the same time• When two conditions cannot occur together

– Excludes2• Represents “Not included here”• The condition excluded is not part of the condition represented

by the code• It is acceptable to use both the code and the excluded code

together, when appropriateOGCR section 1.A.12.a.b

ICD-10 Structure

• “Code First” and “Use Additional Code”– ICD-10 has a coding convention that requires the

underlying condition be sequenced first followed by the manifestation.

– These instructional notes indicate the proper sequencing order of the codes.

OGCR section 1.A.13

• The “-” indicates there are additional reporting options


Most Common Diagnosis Codes

HypertensionICD-9 Code ICD-10 Code Description Excludes1 Excludes2

401.1401.9401.0

I10 Essential (Primary) HypertensionIncludes: high blood pressure, Hypertension (arterial) (benign) (essential) (malignant) (systemic)

• Hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16)

• Neonatal hypertension (P29.2)

• Primary pulmonary hypertension (I127.0)

• Essential (primary) hypertension involving vessels of brain (I60-I69)

• Essential (primary) hypertension involving vessels of eye (H35.0-)

Hypertensive Diseases Categories (I10-I15)

The use additional codes and Excludes1 codes apply for all categories.

(I10-I15) Use additional code to identify:• Exposure to

environmental tobacco smoke (Z77.22)

• History of tobacco use (Z87.891)

• Occupational exposure to environmental tobacco smoke (Z57.31)

• Tobacco dependence (F17.-)

• Tobacco use (Z72.0)

• Hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11. O13-O16)

• Neonatal hypertension (P29.2)

• Primary Pulmonary hypertension (I27.0)

Hypertension cont.

ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

402.01402.11402.91

I11.0 Hypertensive Heart Disease with heart failure• Use additional code to

identify type of heart failure (I50.-)

N/A N/A

402.00402.10402.90

I11.9 Hypertensive Heart Disease without heart failure

N/A N/A

403.01403.11403.91

I12.0 Hypertensive Chronic Kidney Disease with stage 5 Chronic Kidney Disease or end stage renal disease.• Use additional code to

identify the stage of chronic kidney disease (N185.5, N18.6)

• Hypertension due to Kidney Disease (I15.0, I15.1)

• Renovascular Hypertension (I15.0)

• Secondary Hypertension (I115.-)

Acute Kidney Failure (N17.-)

403.00403.10403.90

I12.9 Hypertensive Chronic Kidney Disease with stage 1-4 Chronic Kidney Disease, or unspecified Chronic Kidney Disease.• Use additional code to

identify the stage of chronic kidney disease (N18.1-N18.9)

• Hypertension due to Kidney Disease (I15.0, I15.1)

• Renovascular Hypertension (I15.0)

• Secondary Hypertension (I115.-)

Acute Kidney Failure (N17.-)

Hypertension cont.ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

404.01404.11404.91

I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1-4 chronic kidney disease, or unspecified chronic kidney disease• Use additional code to identify

type of heart failure (I50.-)• Use additional code to identify

stage of chronic kidney disease (N18.1-NN18.4, N18.9)

N/A N/A

404.00404.10404.90

I13.10 Hypertensive Heart and Chronic Kidney Disease without heart failure, with stage 1-4 chronic kidney disease, or unspecified chronic kidney disease.• Use additional code to identify

the stage of chronic kidney disease (N18.1-N18.4, N18.9)

N/A N/A

404.02404.12404.92

I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease or end stage renal disease.• Use additional code to identify

the stage of chronic kidney disease (N18.5, N18.6)

N/A N/A

404.03404.13404.93

I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease.• Use additional code to identify

type of heart failure (I50.-)• Use additional code to identify

the stage of chronic kidney disease (N18.5. N18.6)

N/A N/A

Hypertension cont.ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

405.01405.11405.91

I15.0 Renovascular Hypertension• Code also underlying

condition

Postprocedural hypertension (I97.3)

• Secondary hypertension involving vessels of brain (I60-I69)

• Secondary hypertension involving vessels of eye (H35.0-)

405.91 I15.1 Hypertension secondary to other renal disorders• Code also underlying

condition




405.99 I15.2 Hypertension secondary to endocrine disorders• Code also underlying

condition




405.09405.19405.99

I15.8 Other secondary hypertension• Code also underlying

condition




405.99 I15.9 Secondary hypertension, unspecified• Code also underlying

condition




• Hypertension is no longer classified as benign, malignant or unspecified.• ICD-10 Codes have been grouped according to disease progression:

– I10 Essential Hypertension– I11.- Hypertensive Heart Disease– I12.- Hypertensive CKD

» Further subdivided by stage of kidney disease

– I13.- Hypertensive Heart and CKD» Further subdivided by stage of kidney disease

– I15.- Secondary Hypertension

• Transient Hypertension– A code for hypertension is NOT assigned unless the patient has a

documented, established diagnosis of hypertension.• R03.0 Elevated blood pressure reading without diagnosis of hypertension

• Document requirements– Type– Current Status– Associated relationships

Hypertension Documentation Tips

Acute kidney failure, unspecifiedICD-9 Code ICD-10

CodeDescription Excludes1 Excludes2

584.9 N17.9 Acute kidney failure, unspecified

Applicable To:• Acute kidney

injury (nontraumatic)

• Posttraumatic renal failure (T79.5)

• traumatic kidney injury (S37.0-)

There are more specific code choice selections below:

585.5 N17.0 Acute kidney failure with tubular necrosis

583.6584.6

N17.1 Acute kidney failure with acute cortical necrosis

583.7584.7

N17.2 Acute kidney failure with medullary necrosis

584.8 N17.8 Other acute kidney failure

• Indicate any associated underlying condition• Indicate acute renal failure type

Documentation Tips

Chronic kidney diseaseICD-9 Code ICD-10


585.9 N18.9 Chronic kidney disease, unspecified

Applicable To:• Chronic renal disease• Chronic renal failure NOS• Chronic renal insufficiency• Chronic uremia

N/A N/A


585.1 N18.1 Chronic kidney disease, stage 1

585.2 N18.2 Chronic kidney disease, stage 2 (mild)

585.3 N18.3 Chronic kidney disease, stage 3 (moderate)

585.4 N18.4 Chronic kidney disease, stage 4 (severe)

585.5 N18.5 Chronic kidney disease, stage 5

585.6 N18.6 End stage renal disease

Code first any associated:diabetic chronic kidney disease (E08.22, E09.22, E10.22, E11.22, E13.22)hypertensive chronic kidney disease (I12.-, I13.-)

Use additional code to identify kidney transplant status, if applicable, (Z94.0)

• If both a stage of CKD and ESRD are documented, assign code N18.6 only.• Chronic kidney disease and kidney transplant status

– Patients who have undergone kidney transplant may still have some form of chronic kidney disease (CKD) because the kidney transplant may not fully restore kidney function. Therefore, the presence of CKD alone does not constitute a transplant complication. Assign the appropriate N18 code for the patient’s stage of CKD and code Z94.0, Kidney transplant status.

– If a transplant complication such as failure or rejection or other transplant complication is documented Code T86.1- should be assigned for documented complications of a kidney transplant.

Documentation Tips

• Chronic kidney disease with other conditions– Patients with CKD may also suffer from other serious conditions, most commonly

diabetes mellitus and hypertension. The sequencing of the CKD code in relationship to codes for other contributing conditions is based on the conventions in the Tabular List.

– Hypertensive chronic kidney disease - Assign codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present. Unlike hypertension with heart disease, ICD-10-CM presumes a cause-and-effect relationship and classifies chronic kidney disease with hypertension as hypertensive chronic kidney disease.

– The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease.

– If a patient has hypertensive chronic kidney disease and acute renal failure, an additional code for the acute renal failure is required.

Documentation Tips

EdemaICD-9 Code ICD-10


782.3 R60.9 Edema, unspecified

Applicable To:• Fluid retention NOS

• Angioneurotic edema (T78.3• Ascites (R18.-)• Cerebral edema (G93.6)• Cerebral edema due to birth

injury (P11.0)• Edema of larynx (J38.4)• Edema of nasopharynx

(J39.2)• Edema of pharynx (J39.2)• Gestational edema (O12.0-)• Hereditary edema (Q82.0)• Hydrops fetalis NOS (P83.2)• Hydrothorax (J94.8)• Nutritional edema (E40-E46)• Newborn edema (P83.3)• Pulmonary edema (J81.-)

N/A


782.3 R60.0 Localized edema

782.3 R60.1 Generalized edema

Identify:• Edema type• Malnutrition type• Trimester (Gestational)

Documentation Tips

Use of symptom codes• Codes that describe symptoms and signs are acceptable for reporting purposes when a

related definitive diagnosis has not been established (confirmed) by the provider.Use of a symptom code with a definitive diagnosis code• Codes for signs and symptoms may be reported in addition to a related definitive diagnosis

when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code.Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

Combination codes that include symptoms• ICD-10-CM contains a number of combination codes that identify both the definitive

diagnosis and common symptoms of that diagnosis. When using one of these combination codes, an additional code should not be assigned for the symptom.)

Documentation Tips

Anemia in chronic diseases

ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

285.21 D63.1 Anemia in chronic kidney disease

Applicable to:Erythropoietin resistant anemia (EPO resistant anemia)

Code firstunderlying chronic kidney disease (CKD) (N18.-)

• refractory anemia (D46.-)

• refractory anemia with excess blasts in transformation [RAEB T] (C92.0-)

N/A


285.29 D63.8 Anemia in other chronic diseases classified elsewhere

Code first underlying disease, such as:• diphyllobothriasis (B70.0)• hookworm disease (B76.0-B76.9)• hypothyroidism (E00.0-E03.9)• malaria (B50.0-B54)• symptomatic late syphilis (A52.79)• tuberculosis (A18.89)

• Identify:– Anemia type– Nutritional Deficiency Anemia type– Bone Marrow Failure Anemia type– Hemolytic Anemia type– Other causes of Anemia

Anemia, unspecified Documentation Tips

Heart failure, unspecifiedICD-9 Code ICD-10 Code Description Excludes1 Excludes2

428.0 I50.9 Heart failure, unspecified

Applicable To:• Biventricular (heart) failure NOS• Cardiac, heart or myocardial

failure NOS• Congestive heart disease• Congestive heart failure NOS• Right ventricular failure

(secondary to left heart failure)

• Cardia arrest (I46.-)

• Neonatal cardiac failure (P29.0)

• fluid overload (E87.70)

N/A

Code first:• Heart failure complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8)• Heart failure following surgery (I97.13-)• Heart failure due to hypertension (I11.0)• Heart failure due to hypertension with chronic kidney disease (I13.-)• Obstetrics surgery and procedures (O75.4)• Rheumatic heart failure (I09.81)

1) Hypertension with Heart Disease Heart conditions classified to I50.- or I51.4-I51.9, are assigned to a code from category I11, Hypertensive heart disease, when a causal relationship is stated (due to hypertension) or implied (hypertensive). Use an additional code from category I50, Heart failure, to identify the type of heart failure in those patients with heart failure.

Heart failure, unspecified Documentation Tips

Secondary hyperparathyroidism of renal originICD-9 Code ICD-10 Code Description Excludes1 Excludes2

588.81 N25.81 Secondary hyperparathyroidism of renal origin

• Metabolic disorders classifiable to E70-E88

• Secondary hyperparathyroidism, non-renal (E21.1)

• disorders of kidney and ureter with urolithiasis (N20-N23)

DiabetesICD-9 Code ICD-10 Code Description Excludes1 Excludes2

250.00 E11.9 Type 2 Diabetes mellitus without complications• Diabetes (mellitus)

due to insulin secretory defect

• Diabetes (NOS)• Insulin resistant

diabetes (mellitus)

Use additional code to identify any insulin use (Z79.4)

• Diabetes mellitus due to underlying condition (E08.-)

• Drug or chemical induced diabetes mellitus (E09.1-)

• Gestational diabetes (O24.4-)

• Neonatal diabetes mellitus (P70.2)

• Postpancreatectomy diabetes mellitus (E13.-)

• Postprocedural diabetes mellitus (E13.-)

• Secondary diabetes mellitus NEC (E13.-)

• Type 1 diabetes mellitus (E10.-)

N/A

Diabetes is a chronic condition that requires multi-specialty management. • The documentation should indicate relevant details regarding the

management of each case as it relates to the services rendered or actions taken to coordinate the patients care.

• The HPI, at a minimal, should include some indication of the historical timeline or duration of the illness, levels as it relates to the date of service, manifestations or impairments associated with the condition and effectiveness of current medication regimen.

• The examination should notate any physical signs related to the diabetic conditions. (Ulcers, nails, edema, discoloration, sensitivity to touch)

Diabetes Documentation Tips

Other disorders of fluid, electrolyte and acid-base balanceICD-9 Code ICD-10 Code Description Excludes1 Excludes2

276.9 E87.8 Other disorders of electrolyte and fluid balance, not elsewhere classified

Applicable to:• Electrolyte imbalance NOS• Hyperchloremia• Hypochloremia

• diabetes insipidus (E23.2)• electrolyte imbalance

associated with hyperemesis gravidarum (O21.1)

• electrolyte imbalance following ectopic or molar pregnancy (O08.5)

• familial periodic paralysis (G72.3)

N/A


276.0 E87.0 Hyperosmolality and hypernatremia

276.1 E87.1 Hypo-osmolality and hyponatremia

276.2 E87.2 Acidosis

276.3 E87.3 Alkalosis

276.4 E87.4 Mixed disorder of acid-base balance

276.7 E87.5 Hyperkalemia

276.8 E87.6 Hypokalemia

276.69 E87.70 Fluid overload, unspecified

276.61 E87.71 Transfusion associated circulatory overload

276.69 E87.79 Other fluid overload

Atherosclerotic heart disease of native coronary artery without angina pectorisICD-9 Code ICD-10 Code Description Excludes1 Excludes2

414.00 I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris

Applicable To:• Atherosclerotic heart

disease NOS

N/A • atheroembolism (I75.-)• atherosclerosis of coronary artery

bypass graft(s) and transplanted heart (I25.7-)414.01 I25.10

Use additional code, if applicable, to identify:• coronary atherosclerosis due to calcified coronary lesion (I25.84)• coronary atherosclerosis due to lipid rich plaque (I25.83)

Use additional code to identify:• presence of hypertension (I10-I15)• chronic total occlusion of coronary artery (I25.82)• exposure to environmental tobacco smoke (Z77.22)• history of tobacco use (Z87.891)• occupational exposure to environmental tobacco smoke (Z57.31)• tobacco dependence (F17.-)• tobacco use (Z72.0)

• Identify:– Coronary Disease Associated Artery/Lesion Type– Native verses transplanted heart– Associated Angina

Documentation Tips

HyperlipidemiaICD-9 Code ICD-10 Code Description Excludes1 Excludes2

272.4 E78.4 Other Hyperlipidemia• Familial

combined hyperlipidemia

• Sphingolipidosis (E75.0-E75.3)

N/A

272.4 E78.5 Hyperlipidemia, unspecified

There are more specific code choice selections available below:

272.0 E78.0 Pure Hypercholesterolemia

272.1 E78.1 Pure Hypercholesterolemia

272.2 E78.2 Mixed Hyperlipidemia

272.3 E78.3 Hyperchylomicronemia

272.5 E78.6 Lipoprotein deficiency

• Type– Mixed– Other– Unspecified

Hyperlipidemia Documentation Tips

HypotensionICD-9 Code ICD-10 Code Description Excludes1 Excludes2

458.9 I95.9 Hypotension, unspecified • cardiovascular collapse (R57.9)• maternal hypotension

syndrome (O26.5-)• nonspecific low blood pressure

reading NOS (R03.1)

N/A


I95.0 Idiopathic hypotension

I95.1 Orthostatic hypotension

I95.2 Hypotension due to drugsUse additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

I95.3 Hypotension of hemodialysis

I95.81 Postprocedural hypotension

I95.89 Other hypotension

Other and unspecified abnormal findings in urineICD-9 Code ICD-10 Code Description Excludes1 Excludes2

791.9 R82.90 Unspecified abnormal findings in urine

• abnormal findings on antenatal screening of mother (O28.-)

• diagnostic abnormal findings classified elsewhere - see Alphabetical Index

• specific findings indicating disorder of amino-acid metabolism (E70-E72)

• specific findings indicating disorder of carbohydrate metabolism (E73-E74)

N/A

R82.99 Other abnormal findings in urine


R82.0 Chyluria

R82.1 Myoglobinuria

R82.2 Biliuria

R82.3 Hemoglobinuria

R82.4 Acetonuria

R82.5 Elevated urine levels of drugs, medicaments and biological substances

R82.6 Abnormal urine levels of substances chiefly nonmedicinal as to source

R82.7 Abnormal findings on microbiological examination of urine

R82.8 Abnormal findings on cytological and histological examination of urine

All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection.

• Site specificity• Document notation of qualifiers

– Exacerbation– Manifestations– Relapse– Status– Stages

• Indicate acute or chronic• Indicate underlying or external cause factors

– Medication– Smoke– Accidents– Mechanical failure

• Laterality– Bilateral– Right – Left

Documentation – Start Now

• Episode of Care for injuries, poisoning, external causes and other conditions– Initial Encounter

• Use while the patient is receiving active treatment of the condition– Active treatment includes surgical treatment, an emergency encounter, and

evaluation and treatment by a new physician

– Subsequent Encounter• Used on encounter after the patient has received active treatment of

the condition and is receiving routine care for the condition during the healing or recovery phase.

– Medication adjustments, aftercare, device adjustments, cast change

– Sequela• Used for complications or conditions that arise as a direct result of a

condition, late effect


• Combination codes that capture– Etiology and manifestation– Related conditions– Disease, injury or other medical condition and

complications– Disease or other medical conditions and common signs or

symptoms

• Add ICD-10 Codes to patient Problem List


UnderdosingUnderdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction. For underdosing, assign the code from categories T36-T50 (fifth or sixth character “6”).

Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded.

Noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.6-Y63.9) codes are to be used with an underdosing code to indicate intent, if known.

OGCR Section 1.C.19.e.5.c

Official Guidelines for Coding and Reporting

[email protected]

Centers for Disease Control and Prevention (ICD-10-CM)http://www.cdc.gov/nchs/icd/icd10cm.htm

Questions

mailto:[email protected]

http://www.cdc.gov/nchs/icd/icd10cm.htm

http://www.cdc.gov/nchs/icd/icd10cm.htm

Nephrology ICD-10 CM Training. ICD-10-CM will be valid for dates of service on or after October 1,...

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