Currentindependence_administratorsPolicy N/A

Chronic kidney disease (CKD) documentation and coding guidance

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Guidance on clinical definition, staging, and ICD-10 documentation/coding best practices for chronic kidney disease intended for providers and coding staff working with Independence Administrators products.

Policy Summary

Payerindependence_administrators

PolicyChronic kidney disease (CKD) documentation and coding guidance

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 20, 2019

Last ReviewMar 20, 2019

Next Review DateN/A

Key ActionInclude the patient's most recent GFR in documentation and record dialysis dependence (Z99.2) or kidney transplant status (Z94) at least annually.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

eGFR <60Diagnostic threshold highlighted

Stages 1–5Staging ranges provided

Z99.2 / Z94ICD-10 documentation items

ICD-10 guidelinesReferences cited

Definitions and CKD Overview

Chronic kidney disease (CKD) — definition and diagnostic context

DefinitionChronic kidney disease (CKD): a multisystem disease with progressive loss of kidney function, diagnosed by kidney damage (e.g., urine albumin >30 mg/g creatinine) and/or a sustained eGFR <60 mL/min/1.73 m2 for more than three months.

Primary measurementKidney function is primarily measured by estimated glomerular filtration rate (eGFR).

Evidence of kidney damageExamples include urine albumin >30 mg/g creatinine.

Duration requirementDiagnostic criteria require abnormalities (eGFR <60 or kidney damage) to be present for more than three months.

Intended useGuidance for providers and coding staff on clinical definition and documentation of CKD (informational).

CKD stages (1–5) — stage names and eGFR ranges

Stage 1eGFR ≥90 mL/min/1.73 m2 with evidence of kidney damage.

Stage 2eGFR 60–89 mL/min/1.73 m2 (kidney damage with mild decrease in GFR).

Stage 3aeGFR 45–59 mL/min/1.73 m2 (moderate decrease in GFR; mild–moderate).

Stage 3beGFR 30–44 mL/min/1.73 m2 (moderate–severe decrease in GFR).

Stage 4eGFR 15–29 mL/min/1.73 m2 (severe decrease in GFR).

Stage 5eGFR <15 mL/min/1.73 m2 or kidney failure.

ICD-10 Documentation and Coding Guidance

ICD-10 example codes and mappingsICD-10

Z99.2	Dependence on renal dialysis
Z94	Kidney transplant status
I12.0	Hypertensive chronic kidney disease with stage 5 CKD or ESRD (contextual guidance)
I12.9	Hypertensive CKD (contextual mapping in document)
E08.22	Diabetes mellitus due to underlying condition with diabetic CKD (example mapping)
E10.22	Type 1 diabetes with diabetic CKD (example mapping)

CKD diagnostic thresholds and staging — criteria and stage thresholds

Diagnostic thresholdCKD is present when eGFR <60 mL/min/1.73 m2 for more than three months or when there is evidence of kidney damage (e.g., urine albumin >30 mg/g creatinine).

Stage 1 criteriaeGFR ≥90 mL/min/1.73 m2 plus evidence of kidney damage.

Stage 2 criteriaeGFR 60–89 mL/min/1.73 m2 (kidney damage with mild GFR decrease).

Stage 3 splitStage 3a: eGFR 45–59; Stage 3b: eGFR 30–44 mL/min/1.73 m2.

Advanced stagesStage 4: eGFR 15–29; Stage 5: eGFR <15 or kidney failure.

Documentation and Provider Actions for Coding

Documentation Required

Document most recent GFR and annual dialysis/transplant status

Include the patient’s most recent GFR lab result in the clinical documentation. For patients currently receiving dialysis, document Dependence on Renal Dialysis using Z99.2. For patients with a kidney transplant, document kidney transplant status at least once annually using Z94. Also include additional codes to document CKD stage and relevant comorbidities (for example, hypertensive CKD, diabetic CKD, hypertensive heart and CKD) per ICD-10 guidance.

Document most recent eGFR in the medical record.
If on dialysis, record Z99.2 (Dependence on Renal Dialysis).
If transplanted, record Z94 (Kidney Transplant Status) at least annually.
Use additional ICD-10 codes to indicate CKD stage and associated comorbidities as described in documentation guidance.

Policy Summary

Payerindependence_administrators

PolicyChronic kidney disease (CKD) documentation and coding guidance

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 20, 2019

Last ReviewMar 20, 2019

Next Review DateN/A

Key ActionInclude the patient's most recent GFR in documentation and record dialysis dependence (Z99.2) or kidney transplant status (Z94) at least annually.

SourceLink

On This Page

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Currentindependence_administratorsPolicy N/A

Chronic kidney disease (CKD) documentation and coding guidance

Customize your policy alerts

Sign up for all independence_administrators policy alerts

Know when independence_administrators releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

Payerindependence_administrators

PolicyChronic kidney disease (CKD) documentation and coding guidance

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 20, 2019

Last ReviewMar 20, 2019

Next Review DateN/A

Key ActionInclude the patient's most recent GFR in documentation and record dialysis dependence (Z99.2) or kidney transplant status (Z94) at least annually.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

eGFR <60Diagnostic threshold highlighted

Stages 1–5Staging ranges provided

Z99.2 / Z94ICD-10 documentation items

ICD-10 guidelinesReferences cited

Definitions and CKD Overview

Chronic kidney disease (CKD) — definition and diagnostic context

Primary measurementKidney function is primarily measured by estimated glomerular filtration rate (eGFR).

Evidence of kidney damageExamples include urine albumin >30 mg/g creatinine.

Duration requirementDiagnostic criteria require abnormalities (eGFR <60 or kidney damage) to be present for more than three months.

Intended useGuidance for providers and coding staff on clinical definition and documentation of CKD (informational).

CKD stages (1–5) — stage names and eGFR ranges

Stage 1eGFR ≥90 mL/min/1.73 m2 with evidence of kidney damage.

Stage 2eGFR 60–89 mL/min/1.73 m2 (kidney damage with mild decrease in GFR).

Stage 3aeGFR 45–59 mL/min/1.73 m2 (moderate decrease in GFR; mild–moderate).

Stage 3beGFR 30–44 mL/min/1.73 m2 (moderate–severe decrease in GFR).

Stage 4eGFR 15–29 mL/min/1.73 m2 (severe decrease in GFR).

Stage 5eGFR <15 mL/min/1.73 m2 or kidney failure.

ICD-10 Documentation and Coding Guidance

ICD-10 example codes and mappingsICD-10

Z99.2	Dependence on renal dialysis
Z94	Kidney transplant status
I12.0	Hypertensive chronic kidney disease with stage 5 CKD or ESRD (contextual guidance)
I12.9	Hypertensive CKD (contextual mapping in document)
E08.22	Diabetes mellitus due to underlying condition with diabetic CKD (example mapping)
E10.22	Type 1 diabetes with diabetic CKD (example mapping)

CKD diagnostic thresholds and staging — criteria and stage thresholds

Diagnostic thresholdCKD is present when eGFR <60 mL/min/1.73 m2 for more than three months or when there is evidence of kidney damage (e.g., urine albumin >30 mg/g creatinine).

Stage 1 criteriaeGFR ≥90 mL/min/1.73 m2 plus evidence of kidney damage.

Stage 2 criteriaeGFR 60–89 mL/min/1.73 m2 (kidney damage with mild GFR decrease).

Stage 3 splitStage 3a: eGFR 45–59; Stage 3b: eGFR 30–44 mL/min/1.73 m2.

Advanced stagesStage 4: eGFR 15–29; Stage 5: eGFR <15 or kidney failure.

Documentation and Provider Actions for Coding

Documentation Required

Document most recent GFR and annual dialysis/transplant status

Document most recent eGFR in the medical record.
If on dialysis, record Z99.2 (Dependence on Renal Dialysis).
If transplanted, record Z94 (Kidney Transplant Status) at least annually.
Use additional ICD-10 codes to indicate CKD stage and associated comorbidities as described in documentation guidance.

Policy Summary

Payerindependence_administrators

PolicyChronic kidney disease (CKD) documentation and coding guidance

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 20, 2019

Last ReviewMar 20, 2019

Next Review DateN/A

Key ActionInclude the patient's most recent GFR in documentation and record dialysis dependence (Z99.2) or kidney transplant status (Z94) at least annually.

SourceLink

On This Page