Q&A: Claiming HCCs for CKD and diabetes

Q: A patient had a kidney/pancreas transplant. The dialysis fistula he had is not working, but remains in place and unused for over a year. He has stable stage IV chronic kidney disease (CKD). His diabetes is no longer being treated, and A1c, and blood sugars have been great. Should we be claiming the HCC 134, or 137?

And, even though the kidney transplant was because of ongoing diabetes, but is now cured, the diabetes mellitus (DM) type I with chronic complications is now totally gone. Correct?

A: As long as the physician documented the diabetes as being “cured,” then yes, the DM type 1 with chronic complications would no longer be coded. Therefore, it would no longer lead to the HCCs regarding DM.

Based on the information you provided, the presence of the shunt (HCC 134) and the CKD stage IV (HCC 137) belong to the renal hierarchy HCC 134, 135, 136, and 137. We would apply the highest level appropriate for the patient. In this case, that would be HCC 134. Only one HCC per hierarchy can be applied, which would lead to dropping HCC 137.

Editor’s Note: Sharme Brodie RN, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com/courses/10040/overview.