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Nephrology Coding Guide: Best Practices for Accurate Billing and More Revenue

February 12, 2019

Nephrology-CodingWith the implementation of ICD-10 came the need to code with a significantly higher level of specificity. Over the past few years, more regulations and new codes have been released, making nephrology coding even more complex. Along with navigating new levels of specificity and new codes, nephrology practices must also deal with additional requirement from their payers. Staying on top of all new latest guidelines for ICD-10, E&M, and CPT coding is challenging, so we’ve put together a helpful nephrology coding guide to provide you with the best practices for accurate nephrology coding from documenting renal failure to codes for diabetes to essential tips for documenting complications of care. 

Nephrology Documentation Requirements for Accurate Coding 

Today, submitting less specified codes results in penalties and denied claims, not only with Medicare, but also with many private payers. To make sure your nephrology practice is billing for the most specific diagnosis, it’s essential to focus on documenting in more detail. To refresh your memory, nephrology coding will require that you document the following: 

  • The onset of care
  • Site specificity (anatomically)
  • Laterality 
  • Etiology and manifestation 
  • The severity of the disease
  • Non-specific/unspecified
  • Combination codes
  • Any conditions that could add to and complicate treatment 

A couple of key points to remember when coding: 

  • Make sure you don’t over code. If it’s not related to the specific visit, you shouldn’t code it. 
  • You should report additional codes when needed by coding conventions. For example, you may need two or more codes to describe a patient’s condition fully. 

How to Document Renal Failure 

Many of the patients seen at a nephrology practice are dealing with renal failure, so it’s important to stay up-to-date on how to best document this condition. First, you’ll need to identify whether the patient’s renal failure is chronic or acute. For acute renal failure, note whether it’s accompanied with medullary necrosis, acute cortical necrosis, tubular necrosis, or another type of acute renal failure. For chronic kidney disease (CKD), make sure you document the correct stage: stage one through five. When patients who have end stage renal disease, it’s important to document whether the patient is compliant or non-compliant with dialysis treatments. Any associated hypertensive or diabetic chronic kidney disease should also be identified.  

Know Your Requirements for Causative Codes 

If you’re using codes N17.0 through N17.9 to code kidney failure, you’re coding N18.1 through N18.5 for chronic kidney disease, or you’re coding N18.6 ESRD, you’ll need to document your causative codes. The most common causative codes include hypertension, glomerular disease, and diabetes. However, if the causative reason for these codes hasn’t been determined definitely, you may need to use: 

  • N17.9 Acute kidney failure that’s unspecified 
  • N19 Unspecified renal failure
  • N26.1 Atrophy of the kidney, terminal 

Codes for Documenting Diabetes Chronic Kidney Disease

When documenting diabetes for your nephrology patients, you’re required to document not only the type of diabetes, but manifestations, complications, and current treatments. If hyperglycemia or hypoglycemia accompanies the patient’s diabetes, it must be identified. If the patient has any manifestations or complications with their diabetes, then you may need to provide some additional details for conditions like: 

  • Site of ulcer
  • Stage of chronic kidney disease
  • Hyperglycemia
  • Gangrene
  • Severity of retinopathy 

Important Diabetes Codes: 

  • Type I Diabetes
    • E10.21 Type I diabetes along with diabetic nephropathy 
    • E10.22 Type I diabetes along with diabetic chronic kidney disease 
      • Additional code should be used to identify the stage of the patient’s chronic kidney disease 
    • E10.29 Type I diabetes with any other diabetic kidney complications like renal tubular degeneration 
  • Type II Diabetes 
    • E11.21 Type II diabetes along with diabetic nephropathy 
    • E11.22 Type II diabetes along with diabetic chronic kidney disease 
      • Use an additional code to identify the stage of the patient’s CKD
    • E11.29 Type II diabetes along with any other diabetic kidney complications like renal tubular degeneration 
  • For insulin use, use additional code Z79.4

Codes for Documenting Hypertensive Chronic Kidney Disease 

For patients for hypertensive chronic kidney disease, there are numerous codes that may be used depending on the patient’s specific diagnosis. Important codes for hypertension include: 

  • I10 Essential or primary hypertension 
  • I12 Hypertensive chronic kidney disease
    • This code requires a fourth digit as well
      • I12.0 Hypertensive chronic kidney disease along with stage 5 chronic kidney disease or end stage renal disease
        • You’ll need to use an additional code to identify the specific stage of chronic kidney disease
      • I12.9 Hypertensive chronic kidney disease, stages one through four chronic kidney disease, or chronic kidney disease that’s unspecified
        • Once again you’ll need to use another code to identify the patient’s stage of chronic kidney disease
  • I13 Hypertensive heart and chronic kidney disease
    • This code also requires you to use a fourth digit 
      • I13.0 Hypertensive heart and chronic kidney disease along with heart failure and stage one thru four chronic kidney disease, or unspecified CKD
        • Use an additional code to indicate the stage of CKD  
        • Use an additional code to note the specific kind of heart failure 
      • I13.10 Hypertensive heart and chronic kidney disease without any heart failure along with stage one through four CKD
        • Stage of CKD must be noted with an additional code
      • I13.11 Hypertensive heart and chronic kidney disease without any heart failure and with end stage renal disease or stage 5 CKD
        • Additional code for the stage of CKD must be used

Tips for Documenting Any Complications of Care

Sometimes complications occur due to the care for the patient’s disease or diseases. If so, they must be documented. Complications of care must be based upon the documentation done by the provider on the relationship between the care or procedure and the condition. The provider also must state that this condition is considered a complication. You can never assume a complication of care. For this reason, it’s essential for providers to be extremely clear in their documentation of complications of care or they cannot be coded.

Following these best practices can help your nephrology clinic improve coding accuracy, preventing costly denials. However, it’s often difficult for your practice to stay updated on the continually coding regulations and codes. That’s where M-Scribe, LLC can help. We work with nephrology practices across the country, and our coders are experienced and well educated in nephrology coding. To learn more about how we can help your practice improve accuracy, reduce denials, and improve revenue, contact M-Scribe today for more information.


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