Nephrology, along with pediatrics and cardiology, will be harder hit than other specialties during the ICD-10 transition. The National Kidney Foundation states that 26 million adults have chronic kidney disease (CKD). Nephrology with see significant changes to coding. Errors in application of new coding can impact the billing of your patients. Take steps to learn the coding and prepare for a smoother transition.
New Coding for Your Nephrology Practice
The new codes and multiple ICD-10 codes necessary for a single ICD-9 code, make it all the more necessary for the staff to train early in order to avoid billing complications. Some of the highlights include:
- Multiple codes required for coding diabetic CKD. IC-9 has a single code for diabetes but the ICD-10 has 5 codes. One code references the stage of CKD and the other is indicative of the form of diabetes with CKD. 250.40, Diabetes type 2 or unspecified with renal manifestation not stated as uncontrolled will be coded as E11.22, Diabetes type 2 with diabetic chronic kidney diseases and N18.1-N18.6, chronic kidney disease stage, or E11.29, Diabetes with other diabetic kidney complication (renal tubular degeneration).
- Hypertensive chronic kidney disease takes two codes in ICD-10. The first code is to indicate that the patient exhibits hypertension and CKD, the second code is for the level of CKD.
- Hypertension coding decreases. I10, essential (primary hypertension), the new coding under ICD-10, now stands in for 401.0, malignant essential hypertension, 401.1, benign essential hypertension, and 401.2, unspecified essential hypertension. The same type of pattern occurs with 403.00, 403.10, and 403.90 which falls under I12.9. Also 403.01, 403.11 and 403.91 become I12.0.
- Chronic kidney disease codes have a single code in reference to their stage. For example, chronic kidney stage III, originally coded as 585.3, becomes N18.3 in ICD-10. Codes begin with a letter, except for U, followed by three to up to seven digits. There are exceptions to this application in ICD-10 coding as in the coding for chronic gout, M1a.
- End stage renal disease coding is a direct one-to-one conversion, as well as acute renal failure coding. Other common condition coding changes include edema, over fluid overload, and hyperlipidemia other and unspecified.
Carole McEwan, ICD-10 project manager at SSM Health Care, recommends that practices give themselves ample time to make the transition to ICD-10. “We estimated that we’ll need 110,000 hours of ICD-10 education (to transition four locations)…It takes time to start rolling out the effort. If you wait too long, the ramp up time will be extremely difficult. You need to get lots of people on the same page and that doesn’t happen overnight.”
Expect a decrease in productivity, whether or not sufficient ICD-10 coding training takes place in the practice. A published study in the Journal of Perspective in Health Information Management. The conclusion was that well-trained providers will take 54.4 percent longer with the ICD-10 coding system. Productivity loss can range from 30 to 50 percent. Providers do get a six month grace period for coding errors. During this period, providers will not be penalized for mistakes but errors will still impact a practice’s payment for services and result in delays and re-submissions.
All of the changes that impact Nephrology coding in ICD-10 make it imperative that providers take the time to ensure that all required staff are competently trained and that the internal systems in place can submit the new coding and manage their medical billing efficently.