The code categories 403 and 250.6 specify to add the additional codes therefore you do need the nephropathy and the CKD codes. Diabetes mellitus (250) is one of a number of disease categories in ICD-9-CM in which the basic disease category serves as the primary code to classify both the disease and its major manifestations.
ICD-9-CM Diagnosis Code 583.9 : Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney Home > 2015 ICD-9-CM Diagnosis Codes > Diseases Of The Genitourinary System 580-629 > Nephritis, Nephrotic Syndrome, And Nephrosis 580-589 > Nephritis and nephropathy not specified as acute or chronic 583-
Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere. ICD-9-CM 583.81 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 583.81 should only be used for claims with a date of service on or before September 30, 2015.
The following crosswalk between ICD-9 to ICD-10 is based based on the General Equivalence Mappings (GEMS) information: E11.21 - Type 2 diabetes mellitus with diabetic nephropathy E11.65 - Type 2 diabetes mellitus with hyperglycemia Code Classification Endocrine, nutritional and metabolic diseases, and immunity disorders (240–279)
Nephropathy due to heavy metals ICD-10-CM Diagnosis Code A36.84 [convert to ICD-9-CM] Diphtheritic tubulo-interstitial nephropathy Diphtheria tubulo-interstitial nephropathy ICD-10-CM Diagnosis Code B58.83 [convert to ICD-9-CM] Toxoplasma tubulo-interstitial nephropathy Toxoplasma tubulointerstitial nephropathy; Toxoplasma pyelonephritis
Follow the instructions in the Tabular List of ICD-10-CM for proper sequencing of these diagnosis codes. For example, if a patient has secondary diabetes as a result of Cushing’s syndrome and no other manifestations, report code E24.9 Cushing’s syndrome, unspecified, followed by E08.9 Diabetes mellitus due to underlying condition without manifestations. If a patient is diagnosed with secondary diabetes due to the adverse effects of steroids, report codes E09.9 Drug or chemical induced diabetes without complications and T38.0X5A Adverse effect of glucocorticoids and synthetic analogues, initial encounter.
If you look in the Alphabetic Index under E11.9 Diabetes/type 2/with, you’ll find codes that describe type 2 diabetes with amyotrophy (E11.44), arthropathy NEC (E11.618), autonomic (poly) neuropathy (E11.43), cataract (E11.36), Charcot’s joints (E11.610) , chronic kidney disease (E11 .22) , etc.
Report encounters related to pregnancy and diabetes using codes in Chapter 15 Pregnancy, Childbirth, and the Puerperium. If a pregnant woman has pre-existing diabetes that complicates the pregnancy, Chapter 15 guidelines instruct us to assign a code from O24 first, followed by the appropriate diabetes code (s) from Chapter 4 (E08–E13). Report codes Z79.4 or Z79.84 if applicable.
Codes for gestational diabetes are in subcategory O24.4. These codes include treatment modality — diet alone, oral hypoglycemic drugs, insulin — so you do not need to use an additional code to specify medication management. Do not assign any other codes from category O24 with the O24.4 subcategory codes.
Type 1.5 diabetes is a form of diabetes in which an adult has features of both type 1 and type 2 diabetes. These patients have also been described with the terms “latent autoimmune diabetes of adults” (LADA), and “slow-progressing type 1 diabetes.” The condition has also been called “double” diabetes, because individuals demonstrate both the autoimmune destruction of beta cells of type 1 diabetes and the insulin resistance characteristic of type 2 diabetes. People with type 1.5 diabetes have autoantibodies to insulin-producing beta cells and gradually lose their insulin-producing capability, requiring insulin within 5–10 years of diagnosis.
The longer someone has diabetes, and the less controlled their blood sugar is, the higher their risk of serious health complications, including: Cardiovascular disease . Kidney damage ( nephropathy)
When you look up "diabetic nephropathy" in the index the code listed is 250.4 (583.81) . The 250.4 needs an extra digit. When you go to 250.4 in the tabular, it tells you what fifth digit to assign in the box. Also, after 250.4, it says "use addition code to identify manifestation" which in this case, it would be nephropathy (583.81) . When you look up 583.81 in the tabular, it directs you to "code first underlying disease" (which is diabetes with renal manifestations.)
Assign code 250.40, Diabetes with renal manifestations, type II [non-insulin dependent type] [NIDDM type] [adult-onset type] or unspecified type, not stated as uncontrolled, and code 403.91, Hypertensive renal disease, with renal failure, for diabetic nephropathy with chronic renal failure and hypertension. Diabetes mellitus is one of several disease categories in ICD-9-CM where one code classifies both the disease and its manifestations. Additional codes may be assigned to further describe the manifestations. The following diagnoses: diabetic renal failure, diabetic uremia, diabetic intercapillary glomerulosclerosis and chronic renal failure, diabetic nephropathy with chronic renal failure, or diabetic nephrosis with chronic renal failure provide a cause-and-effect relationship, requiring that code 250.4X, Diabetes with renal manifestations, be sequenced first.
If you look at 585 category in the tabular, it says "code first, hypertensive CKD if applicable" and directs you to 403.00-403.91.
ICD-9-CM assumes a cause-and-effect relationship and classifies chronic renal failure with hypertension as hypertensive renal disease. At category 403, the note reads "any condition classifiable to 585, 586, 587 with any condition classifiable to 401." This wording indicates that the linkage is so compelling when both conditions are present (hypertension and chronic or unspecified renal failure) that hypertensive renal disease is coded. Therefore, if the physician has not indicated "CRF not due to hypertension," code 403.91, Hypertensive renal disease, unspecified, with renal failure, would be assigned.
The appropriate code from category 585, chronic kidney disease should be used as a secondary code with a code from category 403 to identify the stage of chronic kidney disease.?
Note: All neoplasms, whether functionally active or not, are classified in Chapter 2. Appropriate codes in this chapter (i.e. E05.8, E07.0, E16-E31, E34.-) may be used as additional codes to indicate either functional activity by neoplasms and ectopic endocrine tissue or hyperfunction and hypofunction of endocrine glands associated with neoplasms and other conditions classified elsewhere.
The coding clinic does not state to not code the 585.- code it is clarifying that you do use the the 250.40 and the 403.91 together. The code categories 403 and 250.6 specify to add the additional codes therefore you do need the nephropathy and the CKD codes.