Secondary Hyperparathyroidism

588.81 vs 252.02

If the documentation does not specify that the secondary hyperparathyroidism is of renal origin, however, there is documentation of chronic kidney disease, do you make the assumption that the secondary hyperparathyroidsim is of renal origin?

Thank you!

re: Secondary Hyperparathyroidism

No you never assume the origin, the documentation must state the the hyperparathyroidism is of renal origin. Are you able to query the physician for further information? In every coding class that I took the first rule is " if it is not documented it can't be coded" so in this case ( if you are unable to query the physician pointing out the clinical indicators that would lead you to believe that it is of renal origin...ie labs for further clairification) then you would simply code it as 585.9 CKD, 252.00 Hyperparathyroidism, unspecified. If you can query the physician without leading them and they make some sort of addendum stating that the patient has CKD with secondary hyperparathyroidism and the clinical indicators are present to back that DX the you could use 585.9 CKD along with the 588.1 and you could also for them to state if known the stage of the CKD all of this clairification will help support your coding. Hope this helps

re: Secondary Hyperparathyroidism

[No you never assume the origin, the documentation must state the the hyperparathyroidism is of renal origin. Are you able to query the physician for further information? In every coding class that I took the first rule is " if it is not documented it can't be coded" so in this case ( if you are unable to query the physician pointing out the clinical indicators that would lead you to believe that it is of renal origin...ie labs for further clairification) then you would simply code it as 585.9 CKD, 252.00 Hyperparathyroidism, unspecified. If you can query the physician without leading them and they make some sort of addendum stating that the patient has CKD with secondary hyperparathyroidism and the clinical indicators are present to back that DX the you could use 585.9 CKD along with the 588.1 and you could also for them to state if known the stage of the CKD all of this clairification will help support your coding. Hope this helps] see coding clinic below for some clinical indicators of the stages of CKD:


Chronic Kidney Disease



Effective October 1, 2005, changes have been made to the ICD-9-CM classification to recognize more current terminology related to chronic kidney disease (CKD) rather than imprecise terms like chronic renal failure and chronic renal insufficiency. The descriptor for code 585, Chronic renal failure, has been changed to Chronic Kidney Disease. Code 585 has been expanded to recognize current staging of chronic kidney disease developed by the National Kidney Foundation (NKF).



According to the NKF, chronic kidney disease is defined according to the presence or absence of kidney damage and the level of kidney function. The stages of chronic kidney disease are defined based on the level of kidney function using the glomerular filtration rate (GFR).



Chronic kidney disease often progresses slowly over a period of years. Adverse outcomes of CKD may be prevented through early detection and treatment. Routine laboratory measurements can help in the detection of the earlier stages of CKD.



End-stage kidney disease is a complete or near complete failure of the kidneys' function to excrete wastes, concentrate urine, and regulate electrolytes. It is also called end-stage renal disease (ESRD). Dialysis or kidney transplantation is needed to avoid multiple and severe complications or death from accumulation of fluids and waste products in the body.



The table below shows the National Kidney Foundation's classification of chronic kidney disease.



Stage Description GFR(mL/min/1.73m²)

I Kidney damage with normal or high GFR > 90

II Kidney damage with mild decrease in GFR 60-89

III Moderate decrease in GFR 30-59

IV Severe decrease in GFR 15-29

V Kidney failure >15 (or dialysis)



The clinical information above regarding staging of chronic kidney disease, like any clinical information published in Coding Clinic, is provided as background material to aid the coder's understanding of disease processes. The information is intended to provide the coder with "clues" to identify possible gaps in documentation where provider query may be necessary. It is not intended to replace the need for specific provider documentation to substantiate code assignment.





Revise585 Chronic renal failure Chronic kidney disease

(CKD)



Add Use additional code to identify kidney

transplant status, if applicable (V42.0)



New code585.1 Chronic kidney disease, Stage I



New code585.2 Chronic kidney disease, Stage II

(mild)



New code585.3 Chronic kidney disease, Stage III

(moderate)



New code585.4 Chronic kidney disease, Stage IV

(severe)



New code585.5 Chronic kidney disease, Stage V



New code585.6 End stage renal disease



New code585.9 Chronic kidney disease, unspecified

Chronic renal disease

Chronic renal failure NOS

Chronic renal insufficiency

re: Secondary Hyperparathyroidism

The physician listed the diagnoses as follows:

CKD Stage 3
Secondary hyperparathyroidism

The physician did not state that the secondary hyperparathyroidism was due to the CKD. I am not able to query the physician so I will code 585.3 and 252.02.

Thanks for the information. It was most helpful.