Q&A: Sequencing for diabetic complications, hypertensive renal disease

Q: We have a diabetic patient with chronic kidney disease and hypertension who was admitted for treatment of chronic kidney disease (an Insertion of an arteriovenous graft for dialysis). Which ICD-10-CM code should be sequenced as the principal diagnosis – the diabetic complication code or the hypertensive renal disease code?

A: The sequencing for the principal diagnosis would be based on the condition noted in the documentation as the primary reason for the patient’s visit and/or procedure. 

If both conditions meet the definition for assignment as the principal diagnosis, per the fiscal year 2020 ICD-10-CM Official Guidelines for Coding and Reporting, then either condition can be assigned as the principal diagnosis.

If this is the case, then you have the option of reporting either E11.22 (Type 2 diabetes mellitus with diabetic chronic kidney disease) or a code from category I12.- (hypertensive chronic kidney disease) first.

Editor’s note: Sarah Humbert, RHIA, AHIMA-certified ICD-10-CM/PCS trainer, coding and compliance manager at KIWI-TEK, LLC, and Temeka Davis, RHIT, coding manager at KIWI-TEK, LLC, answered this question during HCPro’s webinar Simplify Complex ICD-10-CM Coding for Diabetes.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.