Chronic Kidney Disease

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Chronic Kidney Disease

  1. 1. Chronic Kidney Diseases K&N PMCC April 19, 2008
  2. 2. What is chronic kidney disease (CKD)? <ul><li>Healthy kidneys remove waste from your blood. The waste then leaves your body in your urine. The kidneys also help control blood pressure and make red blood cells. When the kidneys are damaged, they cannot remove waste from the blood as well as they should. This is called chronic kidney disease. Almost 20 million people in the United States have this disease. The most common causes of CKD are high blood pressure, diabetes and heart disease. CKD can lead to kidney failure, but early treatment can slow or prevent this. Chronic kidney disease can also be caused by infections or urinary blockages. </li></ul>
  3. 3. ESRD Stage 5 on dialysis 585.6 Stage 1 ≤ 90 585.1 Stage 2 60-89 585.2 Stage 3 30-59 585.3 Stage 4 15-29 585.4 Stage 5 <15 585.5
  4. 4. <ul><li>If both a stage of CKD and ESRD are documented assign code 565.6 only. </li></ul><ul><li>Code first hypertensive chronic kidney disease, if applicable. (403.00-403.91. 404.00, 404.93) </li></ul>585.9 Chronic kidney disease, unspecified Chronic renal disease Chronic renal failure NOS Chronic renal insufficiency ESRD Stage 5 on dialysis 585.6 Stage 1 ≤ 90 585.1 Stage 2 60-89 585.2 Stage 3 30-59 585.3 Stage 4 15-29 585.4 Stage 5 <15 585.5
  5. 5. Hypertensive CKD (403.) <ul><li>Excludes: </li></ul><ul><ul><li>Acute renal failure (584.5-584.9) </li></ul></ul><ul><ul><li>Renovascular hypertension (405.01, 405.11, 405.91) </li></ul></ul>Renovascular hypertension is high blood pressure due to narrowing of the arteries that carry blood to the kidneys. It is a form of secondary hypertension.
  6. 6. Hypertensive CKD (403.) <ul><li>Other guidelines: </li></ul><ul><ul><li>Use when conditions classified to 585-587 are present </li></ul></ul><ul><ul><ul><li>585 CKD </li></ul></ul></ul><ul><ul><ul><li>586 Renal Failure, unsp. </li></ul></ul></ul><ul><ul><ul><li>587 Renal sclerosis, unsp. </li></ul></ul></ul>
  7. 7. Hypertensive CKD (403.) <ul><li>Other guidelines: </li></ul><ul><li>ICD-9-CM presumes a cause-and-effect relationship and classifies chronic kidney disease (CKD) with hypertension as hypertensive chronic kidney disease. </li></ul><ul><li>The appropriate code from category 585, Chronic kidney disease, should be used as a secondary code with a code from category 403 to identify the stage of chronic kidney disease. </li></ul>
  8. 8. 403.11 403.10 Benign 403.91 403.01 w/CKD stage V or ESRD 403.90 403.00 w/CKD stage I-IV or unsp. Unspecified Malignant ESRD Stage 5 on dialysis 585.6 Stage 1 ≤ 90 585.1 Stage 2 60-89 585.2 Stage 3 30-59 585.3 Stage 4 15-29 585.4 Stage 5 <15 585.5
  9. 9. Try this: <ul><li>Location: Inpatient hospital Patient: Grace Hargrove Physician: George Orbitz M.D. </li></ul><ul><li>CAPD Progress Note: </li></ul><ul><li>Patient with hypertensive ESRD. The patient was admitted and evaluated regarding her dialysis prescription. Because of her diagnosis of acute peritonitis due to peritoneal dialysis, the plan at this time is to use all of 1.5% Dianeal and 2-liter volumes and do CAPD instead of cycles. The initial bag will contain antibiotic. The gent bag is next. Cultures are pending. We will proceed from there. </li></ul><ul><li>The patient was evaluated after admission. She is empty at the point, and we have yet to place the first bag. Her abdomen is a little tender, and she is bloated. There is no doubt in my mind that we are seeing a developing peritonitis. The concern, of course, is the fact that she has been constipated and the worry is that this may represent a more serious colonic perforation. </li></ul>
  10. 10. 403.91 585.6 996.68 567.9
  11. 11. 584.9, 276.51, 403.10, 585.9, 250.40, 583.81 A patient is admitted to the hospital in acute renal failure due to dehydration. The patient has chronic kidney disease, benign essential hypertension, and Type II diabetes (controlled) with diabetic nephropathy. What would be the correct code assignment?
  12. 12. Sources: <ul><li>ICD-9-CM Guidelines (10.1.2007) </li></ul><ul><li>familydoctor.org </li></ul><ul><li>National Kidney Foundation </li></ul><ul><ul><li>kidney.org </li></ul></ul><ul><li>PMCC 2008 </li></ul>

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