Posts tagged ‘coding clinic’

March 27, 2011

Coding Clinic tackles HTN and renal sclerosis coding

These Q&As come from the Coding Clinic, Fourth Quarter 2010 Page: 137 Coding advice or code assignments contained in this issue effective with discharges October 1, 2010.

Question:
A patient seen in the physician’s office was diagnosed with renal sclerosis due to hypertension. I understand that this should be coded with a code from category 403, Hypertensive chronic kidney disease, but I’m unable to determine what 5th digit should be applied. Please provide some clarification.
Answer:
Assign code 403.90, Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified. The fifth digit of “0” should be assigned since there is no chronic kidney disease stage specified. In addition, assign also code 587, Renal sclerosis, unspecified.

Question:
A patient with renal sclerosis due to hypertension and stage V chronic kidney disease (CKD) is seen in the doctor’s office. How should this be coded?
Answer:
Assign code Assign code 403.91, Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; code 587, Renal sclerosis, unspecified; and code 585.5, Chronic kidney disease, stage V, for a patient with hypertension due to renal sclerosis and stage V CKD. The fifth digit for subcategory 403.9 is selected on the basis of the documented CKD stage.

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December 5, 2010

CVA, V12.54 and Hemiplegia

There seem to be some lingering questions from guidance of a few months ago. This issue is one that never seems to  go away: CVA.In the past, the Coding Clinic had instructed hospitals not to code hemiplegia in acute CVA patients if the hemiplegia had resolved before discharge. (Q2, 1989) A question in the Q2 2009 Coding Clinic asked for reconsideration of this policy, given the significance of the diagnosis and the fact that many patients may be receiving therapy, even though the diagnosis is resolved.

This should not affect home health coding, given we cannot use acute codes in M1020 or M1022. We use late effects. Three codes deal with hemiplegia …

438.20, Hemiplegia affecting unspecified side
438.21, Hemiplegia affecting dominant side
438.22, Hemiplegia affecting nondominant side
We should be able to continue to code these for our therapy patients.

This change should not affect V12.54, history of TIA/CVA. Since all the deficits are resolved before our patients get to us, there are no late effects to deal with. We can still code acute stroke in M1010 and M1016 provided within 14 days.