Cracking the Code

Coding Hypertensive Chronic Kidney Disease

As per the ICD-10-CM guidelines, if we see documentation of both hypertension and chronic kidney disease, we can assume a causal relationship between them (we see this for hypertension and heart disease as well). “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.”

CKD should not be coded as hypertensive if the provider documents the CKD is not related to the hypertension. In this case, they would be coded separately.

“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. See section I.C.14. Chronic kidney disease in the ICD-10-CM guidelines.

If a patient has hypertensive chronic kidney disease and acute renal failure, the acute renal failure should also be coded.

We want to remember to sequence according to the circumstances for the admission/encounter.”

Q: The patient is seen in her doctor’s office and diagnosed with benign hypertension and stage 3 chronic kidney disease. What is the appropriate ICD-10-CM code(s) for this encounter?
A: I12.9, N18.30. Rationale: ICD-10-CM Coding Guideline I.C.9.a.2 states a causal relationship is always assumed with hypertension and chronic kidney disease. Look in the ICD-10-CM Alphabetic Index for Hypertension/kidney/with/stage 1 through stage 4 chronic kidney disease which directs you to I12.9. The note below code I12.9 instructs you to report an additional code for the stage of chronic kidney disease. This is stage 3, unspecified; therefore, N18.30 is also reported. As always, we want to be sure to verify all code selection in the Tabular List.
Reference: FY 2024 ICD-10-CM guidelines and code book
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