Hypertensive Kidney Disease Coding

ICD-9 and ICD-10 both assume a cause-and-effect relationship between chronic kidney disease and hypertension.  When the patient has both conditions, ICD presumes a relationship and codes “Hypertensive Chronic Kidney Disease” (unless the doctor states otherwise).

The coding rules are very similar between the two code sets, but the codes vary.  In ICD-9-CM a code from category 403, Hypertensive Kidney Disease, should be listed first, followed by an additional code to identify the stage of the chronic kidney disease, a code from category 585. Don’t forget to use fourth and fifth digits with the 403 code. Fourth digits available for the 585 code are listed below.

In ICD-10-CM Hypertensive Chronic Kidney Disease code category is I12. Don’t forget to use a fourth digit (either I12.0 or I12.9). This needs to be followed by an additional code from category N18 to specify the stage of the chronic kidney disease.

Here is a breakdown of the stage codes between ICD-10 and ICD-9:

Chronic Kidney Disease ICD-10-CM ICD-9-CM
Stage 1 N18.1 585.1
Stage 2 N18.2 585.2
Stage 3 N18.3 585.3
Stage 4 N18.4 585.4
Stage 5 N18.5 585.5
End Stage Renal disease N18.6 585.6

The healthcare provider needs to document the stage of the chronic kidney disease.

Nancy Reading, RN, BS, CPC, CPC-P, CPC-I, wrote an article on renal failure in the latest September 2015 publication of the Healthcare Business Monthly from AAPC, pages 20-23.  It contains excellent information on the physiology of kidney disease; check it out!

For more information on coding hypertensive chronic kidney disease please see guideline I.C.7.a.3 in ICD-9-CM and guidelines I.C.9.a.3 in ICD-10-CM.

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