Q: When is code I12.9 used?  I thought that was for hypertension with CKD without CHF?

A: Code I12.9 is for hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease.  This code is used when the patient has hypertension and CKD without heart disease.  A patient with hypertension and CKD and heart disease is classified to category I13.  Please note that code I13.0- (Hypertensive heart and chronic kidney disease) on slide 39 in the presentation should have been I12.- (Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease.  However, if the patient had hypertension, hypertensive heart disease, CKD, and diabetes, the codes listed on slide 39 are correct.

Q: In polling question #3, shouldn’t the code for ESRD with hypertension be I12.0?  If documentation says ESRD due to DM and pt has HTN. Do you still code as HTN and DM is related?

A: You are correct that in polling question #2, code I13.11 should be I12.0.  However, the correct answer in this case is still answer #2, E11.22, N18.6, and I10 since the ESRD was specifically linked to the diabetes.  Coding Clinic, Third Quarter 2019: Page 3 states: “When the patient has diabetes, hypertension and chronic kidney disease (CKD) and the provider documents CKD due to diabetes or diabetic CKD, diabetic nephropathy or other similar terminology a causal relationship is indicated, and denotes the CKD is not related to the hypertension. In this case, assign a code for diabetic chronic kidney disease. Do not assign a code for hypertensive CKD, as the hypertension would be coded separately.”

Q: When doctor writes type 1.5 diabetes treated as type 2, I’m told to code as type 2, just wanted to verify.

A: Per Coding Clinic, Third Quarter, 2018: Page 4, type 1.5 diabetes mellitus is assigned to category E13, Other specified diabetes mellitus.  It is incorrect to code it as type 2 diabetes mellitus.

Q: How do you code for gestational diabetes controlled by injectable non-insulin medications?  The codes allow for reporting of GDM controlled by diet, insulin, or oral hypoglycemic drugs, but the 2021 guidelines don’t address injectable non-insulin medication.

A: According to our clinical sources, it is clinically unfeasible that a patient with gestational diabetes mellitus (GDM) would be given an injectable non-insulin medication.

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Senior Consultant

Kristi is a senior consultant with more than 25 years of industry experience; she is responsible for the development of web-based, instructor-led, and webinar training materials; conducting training in ICD-10-CM/PCS and CPT; and performing DRG and APC audits. Kristi has an extensive background in coding education and consulting and is a national speaker and published writer on topics related to ICD-10 and CPT coding and code-based reimbursement. She has designed and developed training programs for inpatient and outpatient hospital-based coding, with a focus on vascular interventional radiology, interventional cardiology, orthopedics, and obstetrics.

Kristi has served the Colorado Health Information Management Association (CHIMA) as board Director, co-chair of the Data Quality Committee, and co-chair for the ICD-10 Task Force. She is also a past president of the Northern Colorado Health Information Management Association (NCHIMA). Kristi is the proud recipient of the 2011 AHIMA Triumph Award for Mentoring for her voluntary work as the “Coder Coach.” She has also received awards from CHIMA for Distinguished Member (2018) and Outstanding Volunteer (2013) and from AHIMA for Roundtable Achievement in Coding Excellence (RACE).

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