Cracking the Code

Hypertension and Chronic Kidney Disease

As per the ICD-10-CM guidelines, we are directed to assign codes from category I12 Hypertensive chronic kidney disease when both hypertension and a condition classified to category N18 Chronic kidney disease (CKD) are present. Like hypertension with heart disease, ICD-10-CM presumes a cause-and-effect relationship and classifies renal failure with hypertension as hypertensive renal disease. The two conditions are only reported separately when the documentation clearly documents the CKD is not related to the hypertension.

The appropriate code from category N18 Chronic kidney disease (CKD) should be reported to identify the stage of the CKD as a secondary diagnosis with a code from category I12. Additionally, if the patient has hypertensive chronic kidney disease and acute renal failure, an additional code for the acute renal failure is required.

Q: True or False: We can assume a cause-and-effect relations between hypertension and CKD?
A: True. Rationale: The ICD-10-CM Official Coding guideline,1.C.9.a.2-I.C.9.a.3, state that hypertension has a presumed cause-and-effect relationship with CKD.
Reference: 2024 ICD-10-CM code book
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