Q&A: CKD relationship

Q: The coders at my facility have stated auto linking congestive heart failure (CHF), hypertension (HTN), and chronic kidney disease (CKD) to the combination code without any documentation of CHF “due to” HTN. There is no documentation of hypertensive heart disease anywhere in the record, and the diagnoses are not linked anywhere in the record. I referenced the Coding Clinic, Fourth Quarter 2008, which states that unless a causal relationship exists between the heart condition and the hypertension—and the physician documents this relationship in the record—each condition requires its own code, and if the documentation does not make that link, an HIM/coding professional must code the two conditions separately.

I understand that ICD-9 Coding Clinics may not apply in ICD-10, but I cannot find any updated guidance. Our coders are going by the Coding Clinic, First Quarter 2016, which still uses the phrase “due to.”

A: I know of no updated instruction that allows heart disease and hypertension to be an assumed relationship. We teach that the provider must clearly state the heart disease is due to (related to, secondary to, etc.) the hypertension.

Of course, the relationship between CKD and hypertension is a combination that can be assumed if found to be present.

For the patient that has the trifecta—is hypertensive, and has heart failure and kidney disease—we still need the provider to clearly state the relationship between the heart disease and the hypertension.

Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, CDI Education Specialist at HCPro in Danvers, Massachusetts, answered this question. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps visit www.hcprobootcamps.com/courses/10040/overview.