Outpatient Dialysis center coding guidelines.

If an individual is seen outpatient for hemodialysis, what diagnosis is considered correct as the first listed? I believe V56.0 (Encounter for extracorporeal dialysis) would be first and 585.6 ESRD for example, is second.

It has been my experience that common practice is to code for example, ESRD first and very often V56.0 isn't coded at all.

I have researched this topic and am still finding different interpretations of the correct coding sequence. I think the guidelines state this clearly, yet I do not see this done correctly.

The dialysis centers say it's just they way it's done, but I am trying to understand why. Am I misunderstanding something?

Any insight that anyone has into outpatient hemodialysis coding would be appreciated.