Chronic kidney disease (CKD) Code 585, Chronic renal failure, has been retitled and expanded to reflect the new clinical practice standard for treating what is now referred to as chronic kidney disease (CKD). The nonspecific term chronic renal failure has been used to mean any degree of kidney failure including end stage renal disease (ESRD). It has also been used interchangeably with the nonspecific term chronic renal insufficiency. Based on the clinical practice guidelines developed by the National Kidney Foundation and supported by the Renal Physician Association, new codes have been created under new category 585, Chronic kidney disease, to classify the different stages of CKD. Stage II, code 585.2, equates to mild CKD, stage III, code 585.3, equates to moderate CKD, and stage IV, code 585.4, equates to severe CKD. End stage renal disease (ESRD), code 585.6, is defined as stage V CKD with dialysis status. Because a patient who has stage V CKD cannot survive without dialysis, most stage V patients are ESRD patients. The terms chronic renal failure, chronic uremia, and chronic renal insufficiency are indexed to code 585.9, Chronic kidney disease, unspecified. Providers should be educated in the use and value of these new codes to greatly improve patient data. They should be encouraged to document the stage of CKD instead of using nonspecific terms. A kidney transplant may not fully restore kidney function, therefore, patients who have undergone a kidney transplant may still have some form of CKD but this does not necessarily indicate failure or rejection. Code V42.0, Kidney replaced by transplant, may be assigned with the appropriate CKD code, based on the patient’s posttransplant stage. The use additional code note under category 585 provides this instruction. Patients with CKD following a transplant should not be assumed to have transplant failure or rejection unless it is documented by the provider. If documentation supports the presence of failure or rejection, then it is appropriate to assign code 996.81, Complication of kidney transplant followed by the appropriate CKD code. Patients with CKD may also suffer from other serious conditions, most commonly diabetes mellitus and hypertension. The sequencing of the CKD code in relationship to codes for other contributing conditions is based on the conventions in the tabular list. Anemia in chronic kidney disease In keeping with the changes made to category 585, the title of code 285.21 has been retitled to “anemia in chronic kidney disease”. The inclusion term “anemia in end stage renal disease” has been added to this code. This title change allows the code to be used with any stage of CKD, not just end stage renal disease. Code 285.21 should always be used with a code from category 585. The sequencing of the codes is based on the circumstances of the encounter. Hypertensive kidney disease The fifth digits for codes under categories 403, Hypertensive renal disease, and 404, Hypertensive heart and renal disease, have been reworded, and the category titles changed to reflect the new terminology at category 585. Category 403 is now titled hypertensive kidney disease and category 404 is now titled hypertensive heart and kidney disease. The revised titles of the fifth digits for category 403 are: 0 without chronic kidney disease 1 with chronic kidney disease The revised titles of the fifthdigits for category 404 are: 0 without heart failure or chronic kidney disease 2 with chronic kidney disease 3 with heart failure and chronic kidney disease. Following the finalization of the titles it has been determined that since the codes under category 585 include the entire continuum of CKD it will be necessary to modify the titles for the fifth digits in categories 403 and 404 again to reflect this. All patients with hypertensive kidney disease have both hypertension and some stage of CKD, so the current code titles for fifthdigit 0 for categories 403 and 404 are invalid. Until new titles become effective only fifthdigit 1 for category 403 should be used. For category 404 only fifthdigits 2 and 3 should be used for patients with CKD. When using any code under category 403 with fifthdigit 1 and any code under category 404 with fifthdigits 2 or 3, a secondary code from category 585 should be used to identify the stage of CKD. Please review the full ICD9CM official coding guidelines for full sequencing instructions.
Pages to are hidden for
"Chronic kidney disease (CKD) Code 585, Chronic renal failure,"Please download to view full document