Help with Benign Hypertension and Renal Failure

[Kat1940]

I am new here and had a tough coding scenario
Benign Hypertension and Renal Failure. I know the coding guidelines about linking the hypertension and the chronic kidney disease, but what about for renal failure?
Would this be 401.1 and 586?
One of my classmates coded the 40310 and 585.9 chronic kidney disease and since this scenario is renal failure and not chronic kidney disease I think she is incorrect,
Any thoughts on this
Thanks

 

[Carolyn Heath]

According to the Faye Brown's 2012 ICD-9-CM Coding Handbook, you will code the renal failure first and benign hypertension second. I also checked with Carol Buck's 2011 Step-by-Step Medical Coding and it said the same thing. The order of the two codes will be:
586 = renal failure, unspecified
401.1 = benign hypertension

 

[Kat1940]

Thanks Carolyn, I am a pharmacy tech too!

 

[Alicia Scott]

CKD or renal failure can be linked with HTN without a link word like "what".
If a person has renal failure the proper code is: 586
If the word "chronic" is used then it is: 585.9
End Stage Renal Disease is 585.6
An easy point about CKD is that if it is a level the last digit = the level: CKD III is 585.3, CKD IV is 585.4

For HTN you go to the hypertension table. 403.90 is the standard code but if your patient has benign HTN then it is 403.10

So, your case stated HTN and RENAL FAILURE. It does not state it is chronic so 404.xx is out. I would go with HTN, Kidney which is 403.10

The answer is:
586, 403.10

 

[marcyreif]

The answer for HTN and Renal failure is correct codes of 586 and 403.10 however thats the wrong order it is HTN then Renal failure look in volume I of your ICD-9-CM book and when you read the fifth digit for HTN it states you a second code for the renal failure.

 

[Alicia Scott]

The order depends on what the patient is being seen for. If he is being seen for CKD it goes first. If he is being seen for HTN it goes first. If however he is being seen for say DM and it is noted that he has CKD and HTN then I would code:
250.00, 585.9, 403.90
The reason being is that CKD is usually a higher RVU then HTN.
The note that is in the manual will also say under CKD if pt has HTN code in addition.