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Insights to Coding and Data Quality
New ICD-9 codes: Understanding chronic kidney disease
by Carla Vandre, RHIT, CCS
Member, Coding & Data Quality Committee
S even new codes, 585.1-585.9, were added to ICD-9-CM in October 1, 2005 to specify the severity of chronic
kidney disease. These code changes were based on a request to incorporate the National Kidney Foundation
(NKF) guidelines for clinical practice into ICD-9-CM. Incorporation of these guidelines included revising
terminology and restructuring the codes based on the clinical stages of the progression of chronic kidney disease.
According to NKF, the term “chronic kidney disease” is more precise than “chronic renal insufficiency” or “chronic
Healthy kidney function removes waste from the blood and leaves proteins, such as albumin. When kidney
function is impaired, albumin is not removed from the waste. The resulting condition, microalbuminuria is an
indication of weakening kidney function. As kidney function deteriorates, the amount of albumin and other proteins in
the urine increases, resulting in frank proteinuria.
Glomerular filtration rate (GFR) is a calculation of how efficiently the kidneys are filtering wastes from the blood.
Normal GFR is about 125 mL per minute or 180 liters per day. To determine GFR, the following values are considered:
• Age: GFR decreases with age.
• Serum creatinine: Usually between 0.8 and 1.6, but may be higher or lower. Measures waste product in the blood
that comes from muscle activity. Creatinine is a waste that kidneys normally remove from the blood. As kidney
function slows down, creatinine level goes up.
• Gender: Men usually have more muscle mass than women, so the calculation is adjusted.
• Race: African Americans tend to have more muscle mass than other ethnicities, so the calculation is adjusted.
Chronic kidney disease is defined as either kidney damage or GFR <60mL/min/1.73 m² for > 3 months.
Healthy kidneys convert the hormone calcitriol to its active form of vitamin D. Calcitriol lets your body absorb calcium
from food you eat. When kidneys are not functioning, calcitrol production is reduced. Therefore, even if you eat
calcium, your body cannot absorb it. Parathryroid glands will secrete parathyroid hormone (PTH) to generate the
release of calcium into the bloodstream from the bones. This function ensures there is enough calcium in your blood.
However, this process will weaken the bones over time. Additional codes from category 588 can be assigned to report
any conditions resulting from impaired renal function.
Many people who develop chronic kidney disease do not have symptoms at first. This is known as the "silent
phase" of chronic kidney disease. As the disease worsens, symptoms of kidney disease become more noticeable and
• Decreased urinary output (oliguria)
• Fluid retention and swelling (edema)
• Loss of appetite (anorexia)
• Nausea and vomiting
• Insomnia or increased sleepiness (lethargy)
• Changes in mental functioning
• Shortness of breath
• Back or flank pain
• Ammonia breath or metal taste in the mouth
Diabetes is the number one cause of kidney disease, responsible for about 40% of all kidney failure. High blood
pressure is the second cause, responsible for about 25%. Arteriosclerosis, cancer, chronic kidney infections, genetic
diseases, autoimmune diseases, and birth defects can also cause kidney disease.
Chronic kidney disease (CKD) is defined according to the presence or absence of kidney damage and the level of
kidney function. The progression of kidney disease may occur quickly over a period of months or at a slower rate over
a number of years. CKD has been classified into five clinical stages of severity, based on the GFR:
Stage 1 (585.1) – Kidney damage with normal or slightly increased GFR (> 90)
Stage 2 (585.2) – Mild kidney damage with GFR 60 – 89
Stage 3 (585.3) – Moderate kidney damage with GRF 30 – 59
Stage 4 (585.4) – Severe kidney damage with GFR 15 – 29
Stage 5 (585.5) – Severe kidney damage or kidney failure with GFR value less than 15
End stage renal disease (585.6) – Severe kidney damage or failure treated by dialysis or organ transplant
Chronic Renal Insufficiency has been reclassified from 593.9 and is included in the new code 585.9 – Chronic Kidney
Disease, unspecified. Acute or unspecified renal insufficiency is indexed to code 593.9.
To ensure proper code assignment, query the physician using the following table as a reference:
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