Partnership Guide 2023Chronic Kidney Disease (CKD)

For an on-demand webinar, click here or navigate to MedicareProviders.Cigna.com > Provider Education > Disease-Specific Training.img1The severity of CKD is classified in stages 1-5 and end stage renal disease. Documentation should include the appropriate stage. Unstaged CKD is classified to unspecified chronic kidney disease.The severity of CKD is classified in stages 1-5 and end stage renal disease. Documentation should include the appropriate stage. Unstaged CKD is classified to unspecified chronic kidney disease.img2https://www.kidney.org/atoz/content/gChronic kidney disease may be caused by another condition. When known, the causal relationship between the two conditions should be confirmed in the documentation. For example, documentation of hypertensive CKD or diabetes with CKD will establish the link.img3img4Example*Diagnostic statement: dialysis patient with hypertensive heart disease, CKD due to HTN/Stage 5, chronic systolic heart failureICD-10 codes

I13.2 Hypertensive heart and chronic kidney disease with heart failure and stage 5 CKD or ESRD.

N18.6 ESRD or chronic kidney disease, stage 5 requiring dialysis

I50.21 Chronic systolic (congestive) heart failure

Z99.2 Dependence on renal dialysis

*The sole purpose of the examples is to demonstrate the application of coding guidelines discussed in the materials. Examples do not represent complete documentation of a condition, nor provide any clinical advice. Each patient and medical record is unique, and assignment of codes depends solely on the distinct documentation within an individual record.
Measuring kidney functionimg5Note: Kidney damage referenced in Stage 1 and Stage 2 corresponds to functional assessment in the form of a urine albumin and sediment assessment or through a renal imaging study to document reduced kidney volume, reduction in cortical thickness and cysts. For Stage 3 and beyond, a functional assessment (i.e., urine albumin, a sediment and/or renal imaging study) is not required.Documentation and Coding of CKD ComplicationsChronic kidney disease may be caused by another condition. When known, the causal relationship between the two conditions should be confirmed in the documentation. For example, documentation of hypertensive CKD or diabetes with CKD will establish the link.If known, documentation should reflect association or link to other conditions. The provider must maintain a separate code assignment that aligns with the five stages of CKD and ESRD. It is important to maintain an additional code assignment to identify dialysis status for ESRD.Here are two examples:

Diabetes Mellitus Type 1 or 2 with Chronic Kidney Disease – Assign the appropriate code from subcategory E10.2 or E11.2, Diabetes mellitus with kidney complications, when diabetes mellitus and CKD are present. Add the appropriate code from category N18 to report the CKD stage. and report the CKD stage with the

Hypertensive CKD – Assign a code from category I12, Hypertensive CKD, when both hypertension and CKD are present. Add the appropriate code from category N18 to report the CKD stage.

Example 1*Diagnostic statement: dialysis patient with hypertensive heart disease, CKD due to HTN/Stage 5, heart failure CHFICD-10 codesI13.2 Hypertensive heart and chronic kidney disease with heart failure and stage 5 CKD or ESRD.N18.6 ESRD or chronic kidney disease, stage 5 requiring dialysisI50.9 Heart failure, unspecified (CHF NOS)Z99.2 Dependence on renal dialysisLab codes to report Kidney Disease Evaluation Measureimg6*The sole purpose of the examples is to demonstrate the application of coding guidelines discussed in the materials. Examples do not represent complete documentation of a condition, nor provide any clinical advice. Each patient and medical record is unique, and assignment of codes depends solely on the distinct documentation within an individual record.Providers must confirm the accuracy of their diagnoses to ensure that diagnosis and coding practices comply with ICD-10-CM Official Guidelines for Coding and Reporting and all applicable legal requirements. Failure to address diagnosis inaccuracies can result in administrative sanctions and potential financial penalties. Accurate coding and submission activities allow us to provide the best benefits and resources possible to our customers.This guide is informational and not meant to replace the clinician’s judgment when caring for the patient.Content updated April 2023.2023 Medicare Advantage Partnership GuideWelcomeContentsDocumentation Best Practices2023 Medicare Advantage ICD-10-CM Quick Reference Code GuideDisease-Specific Webinar LinksConditioning Reporting GuideReporting Common ConditionsAtrial FibrillationCancerChronic Kidney Disease (CKD)Chronic Obstructive Pulmonary Disease (COPD)Congestive Heart Failure (CHF)DVT and PEDementiaDiabetes Mellitus (DM)Major DepressionObesityPeripheral Artery Disease (PAD)Substance Use/Abuse/DependenceTobacco and E-Cigarette Use/AbuseSocial Determinants of Health