How to Code for Chronic Kidney Disease (CKD)

by | Published on Nov 28, 2022 | Medical Billing

Chronic Kidney Disease
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Regarded as a leading cause of death in the United States, chronic kidney disease (CKD) involves a slow and progressive loss of kidney function over several years. Also called chronic kidney failure or end-stage renal disease (ESRD), the condition can cause severe damage to the kidneys and reduce their ability to filter wastes and excess fluids from the blood (which are then excreted in the urine). As per reports from the Centers for Disease Control and Prevention (CDC), about 37 million adults in the United States are estimated to have CKD, and most remain undiagnosed.

It is estimated that about 40 percent of people with severely reduced kidney function (not on dialysis) are not aware that they have CKD. If left untreated, the condition can progress to an advanced or end-stage kidney disease causing significant impairment or loss of kidney function. As billing and coding for CK can be complex, nephrologists and other physician specialists treating this condition can rely on medical billing outsourcing companies to meet their billing and coding requirements.

Reports suggest that by 2040, CKD is projected to become the fifth most common cause of years of life lost globally. In the United States, diabetes and high blood pressure are the leading causes of kidney failure, accounting for 3 out of 4 new cases. Other related causes include – obstructed urine flow, kidney artery stenosis, injuries to the kidneys, and usage of certain medications (that can damage the kidneys). In addition, several factors that can increase the risk of the condition include – older age (CKD is more common among people above 60 years), obesity, family history of CKD, having heart disease, smoking and abnormal kidney structure.

Symptoms of CKD

Generally, most people with CKD are not aware that they have the disease as symptoms of the condition do not usually develop in the early stages. Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. Loss of kidney function can cause a buildup of fluid or body waste or electrolyte problems. Typically, by the time a person notices any specific symptoms, the condition may reach an advanced stage. In fact, damage to the kidneys at this stage is irreversible. Depending on the severity of the disease, loss of kidney function can cause severe symptoms like –

  • Hypertension or high blood pressure
  • Sleep problems
  • Persistent itchy skin (when the condition is severe)
  • Nausea and vomiting
  • Muscle cramps
  • More frequent urination (especially at night, in some cases)
  • Fatigue or tiredness
  • Edema, or swollen feet, hands and ankles
  • Decreased urine output
  • Decreased mental sharpness
  • Dart or bloody urine (in some cases)
  • Anemia
  • A loss of appetite

The signs and symptoms of chronic kidney disease are often non-specific. This means they can also be caused by other illnesses. As the kidneys are able to make up for lost function, patients may not develop signs and symptoms until irreversible damage has occurred.

CKD – Diagnosis, Treatment and Medical Codes

As an initial step of diagnosis of chronic kidney disease, physicians may perform a detailed analysis of the patient’s medical history – including personal and family history of the disease. Physicians may also perform a physical examination to check for signs and symptoms. They will conduct a detailed review of several medical conditions like blood pressure or diabetes and ask questions about urinary habits, usage of medications affecting kidney functions, and whether patients have any family members who have kidney disease. Other additional tests may be performed like blood tests, urine tests, imaging tests (for e.g. ultrasound to assess the kidneys’ structure and size) and biopsy (to remove a sample of kidney tissue for testing).

Treatment for the condition may depend on the causes, type and severity of the condition and include a combination of medications and other lifestyle modifications that may generally work to slow or control the related causes. Top treatment modalities include – medications (to low or control cholesterol, high blood pressure, treat anemia, relieve swelling and protect bones) and a lower protein diet (to minimize waste products in the blood). If the kidney disease has become chronic and reached an end-stage, a dialysis or a kidney transplant may be recommended.

ICD-10 Codes for CKD

Nephrologists treating CKD patients must document the symptoms, screening tests and other treatment procedures offered using the right medical codes. Medical billing services provided by experienced billing and coding companies can help in timely claim submissions for accurate reimbursement. ICD-10 codes for CKD include –

  • N18 Chronic kidney disease (CKD)
    • N18.1 Chronic kidney disease, stage 1
    • N18.2 Chronic kidney disease, stage 2 (mild)
  • N18.3 Chronic kidney disease, stage 3 (moderate)
    • N18.30 Chronic kidney disease, stage 3 unspecified
    • N18.31 Chronic kidney disease, stage 3a
    • N18.32 Chronic kidney disease, stage 3b
  • N18.4 Chronic kidney disease, stage 4 (severe)
  • N18.5 Chronic kidney disease, stage 5
  • N18.6 End stage renal disease
  • N18.9 Chronic kidney disease, unspecified

Often, people do not realize that they have the condition until their kidney function is down to 15 percent of its normal capacity. By this time, they may already have CKD and will require dialysis or a kidney transplant. Prevention of this condition depends largely on managing the primary causes, which are diabetes and hypertension. Therefore, controlling diabetes and hypertension can reduce the risk of developing kidney failure in the long run. However, there are other conditions including acute kidney injury and heavy metal poisoning that can cause CKD. Apart from this, people also need to incorporate serious lifestyle changes like – following a balanced diet and regular exercise patterns -as this can help prevent the risk of developing CKD in the long run.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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