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I Don't Understand - Puzzled

Posted: Dec 01, 2011

An 84 year old monitored for diagnoses of renal failure, anemia and hypertension.
586, 285.9, 403.90.

It seems to me that the last code should be 401.90.

I don't understand why the code 403.9 was selected. The guidelines say you should "assign codes from category 403, hypertensive chronic kidney disease, when conditions classified to category 585 are present." There is only the 586, renal disease, present in this scenario. Can anybody tell me why a 403 code is appropriate here?

Could you provide a little more information - See message

[ In Reply To ..]
It sounds as if you may be taking a course where there is no instructor to help. I'm guessing. I may be wrong. I'm also not criticizing you at all if you are enrolled in a course either with no instructors or in one where the instructors don't know very much about coding. I recently talked to a student of one of the two credentialing organizations who can't get an instructor to answer a question. In a case like that, where else can you get an answer other than from strangers on a board who may or may not know the right answer? Let us know more before we try to help.

You Hit the Nail on the Head - Puzzled

[ In Reply To ..]
Yes, I am a student. My instructor's reply was "as clear as mud". Too late to change now. This is my final course. What I stated in my original message was all of the information in the question, other than the fact that the patient had labs performed--magnesium, iron, phosphorus and total protein serum. The values for the labs were not given, just stated that those were his labs.

I don't know the answer, but maybe someone will - nm

[ In Reply To ..]
nm

Hi - jm

[ In Reply To ..]
If the diagnosis is Chronic kidney failure, that codes to a 585.x. If it is acute renal failure, that is 584.9. If it is chronic then ICD-9 assumes a cause and effect relationship when both chronic kidney disease and hypertension are present. However, if the diagnosis is acute kidney failure without chronic kidney disease, there is no assumption and you would not code it as 403.91. Read the guidelines, that will help connect the dots too!

jm is correct - sm

[ In Reply To ..]
The answer above from jm is correct.

586 is neither chronic nor acute renal failure. You would only use the 403.9x code if the question said that the patient had chronic renal failure.

There is a good explanation for all of this in Faye Brown. If your course does not use that book, it is well worth buying it on your own. It's a life-saver on the job.

Hypertension causes chronic renal failure so often that ICD-9 simply assumes that there is a causal relationship. This does not hold true for acute renal failure, which is not the same condition at all. For hypertension and acute renal failure, ICD-9 does not assume a causal relationship.

That, of course, requires that the documentation specifies if this is acute or chronic renal failure. Your question doesn't say which it is . . . it only says renal failure. "Renal failure" codes to 586 and no assumptions are made about its relationship with hypertension.

On the job, documentation that said only "renal failure" might be a query opportunity. Physicians should be encouraged to be clear about which it is. If they mean chronic, say it's chronic. If they mean acute, say it's acute. If they mean the labs are off, then use the correct medical term for what those labs indicate.

What book did this question come from? You should write to the editors to request that the answer key be corrected.

This is a famous certification topic, by the way. Figuring out the correct answer now and being able to explain it thoroughly will help you. Pencil a small note into your code book about it, too.

Thanks - Puzzled

[ In Reply To ..]
I appreciate that you're able to see my puzzlement over this. When I emailed the instructor about this, her reply was a bunch of gobbledegook in defense of the answer key answer. I will drop a line to the publisher. This problem is from the Step By Step Workbook by Buck.

Ah ha! - sm

[ In Reply To ..]
I knew I'd seen that question somewhere before! It has been several years, so that error has been there for a while. If it shows up on the online test, you'll have to decide if you should answer it using the incorrect textbook answer or the correct one. If your instructor isn't likely to adjust your grade if you give the correct answer . . . hmm. I think that happened to me and that's why I remember that question.

It is very easy for an instructor to accept that the answer key is going to be correct. There is a strong temptation to believe that textbook authors surely know best and that the entire book was checked carefully for errors. In that event, even an experienced and certified instructor's brain can fly out the window while they try desperately to explain the answer in the answer key.

I often think that textbook authors farm the questions out to their friends -- 25 here, 25 there, and so forth. You can see it in books from all kinds of publishers. If the author isn't particularly experienced, except in writing textbooks, then the errors often go unnoticed for years.

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