The Daily Dose
Care Support for Your Patients with Chronic Kidney Disease and Tips for Accurate Diagnostic Coding
A three-year continuous improvement project initiated by the Centers for Medicare & Medicaid Services (CMS) aims to optimize kidney function and improve outcomes for Medicare members with chronic kidney disease (CKD). Early identification and treatment of such patients may slow progression of the disease to end-stage renal disease and delay or avoid the need for dialysis. In connection with this project, CDPHP® has broadened the scope of its efforts to include Medicare members with stages 2 or 3 CKD who also have diabetes and/or hypertension. If you are treating patients with CKD and comorbidity, we can offer them support and provide guidance to help you and your staff accurately code for the disease.
Support for Your Patients with CKD
Our care management team can help your patients manage their disease through education, access to self-management tools, pharmacist consults, and assistance scheduling appointments. Prior to engaging your patients with CKD, a CDPHP care manager will reach out to your practice to discuss a unified strategy for supporting them. Alternatively, you can request support by contacting the CDPHP Care Team at 1-888-94-CDPHP (23747).
CKD Coding Tips
When treating patients with CKD, diagnostic coding to the correct level of specificity is an important tool for tailoring care management strategies to their health needs. It also helps health plans like CDPHP® estimate the cost of providing appropriate care.
Despite its importance, however, accurate ICD-10 diagnosis coding in patients with CKD is challenging, and overuse of unspecified diagnosis codes is a problematic trend. Accurately coding to specificity requires thorough documentation of all conditions and clinical factors impacting a patient’s health. As CKD progresses, the coding must be updated to reflect the latest staging, and clinical documentation must match the designated stage.
Staging Chronic Kidney Disease
Chronic diseases like CKD that are treated on an ongoing basis may be coded and reported each time a patient receives treatment and care for the condition. Likewise, all co-existing conditions that are identified at the time of the patient’s visit and that require or affect patient care, treatment, or management should be documented and coded. The following table outlines the appropriate ICD-10 codes and clinical values delineating the various stages of CKD.
| Stage | Severity | GFR* Value | ICD-10 Codes |
|---|---|---|---|
| Stage I | Normal | GFR > 90 ml/min/1.73 m2 with kidney damage | N18.1 |
| Stage II | Mild | GFR 60-89 ml/min/1.73 m2 with kidney damage | N18.2 |
| Stage III | Moderate | GFR 30-59 ml/min/1.73 m2 | N18.3 |
| Stage IV | Severe | GFR 15-29 ml/min/1.73 m2 | N18.4 |
| Stage V | Kidney failure | GFR < 15 ml/min/1.73 m2 | N18.5 |
| ESRD (End-stage renal disease) | Requiring chronic dialysis or transplantation | GFR < 15ml/min/1.73 | N18.6 |
| CKD Unsp. | Chronic renal disease (CRD), chronic renal failure not otherwise specified (CRF NOS) or chronic renal insufficiency (CRI) | Chronic kidney disease, unspecified | N18.9 |
NOTE: Staging parameters must be chronic, not a one-time event.
*Glomerular filtration rate
Cynthia Farrelly, RN, BSN, Accreditation and Quality Program Manager, CDPHP Quality Enhancement Department
Interested in learning more? Check out this blog article to review some general guidelines for accurate claims coding.
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