ICD Codes: Utility for Classification of CKD by Severity, Treatment and Diagnosis
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1 ICD Codes: Utility for Classification of CKD by Severity, Treatment and Diagnosis Lesley Stevens MD MS Tufts-New England Medical Center Boston, MA Robert Jakob MD Medical Officer, Classifications and Terminologies World Health Organization
2 Identification and Classification of Chronic Kidney Disease Identify and classify CKD for purposes of: Epidemiological studies (study of the disease) Quality improvement (patient care) Surveillance (health care policy) Two methods Laboratory Tests ICD codes
3 Goals of the Presentations History and definition of ICD ICD codes in different countries Use of ICD-9-CM for CKD Specific codes USRDS Modifications to ICD-9-CM for CKD Use of ICD-9-CM codes for classification of CKD by disease ICD-10 update and revision Next steps
4 International Classification of Disease and the World Health Organization ICD was first developed in1893 as the International List of Causes of Death. WHO took over responsibility for the ICD in Recorded in several data sources including health and vital records and used for both epidemiological and health management purposes ICD-9 and ICD-10 are currently in use for morbidity; ICD-11 is in development ICD is modified by individual countries to adapt to specific clinical needs
5 Country ICD Version Codes required for Billing Pt severity effects reimbursement Argentina Both Yes and No No Belgium 9 Yes Yes Brazil 10 Yes No Canada 10 Yes No United Kingdom 10 No No France 10 No No India 10 No No Japan 10 Yes Yes Netherlands 9 & 10 Yes Not Sure Norway 10 Yes Yes Puerto Rico 9 Yes Yes Saudi Arabia Not Sure No Not Sure South Africa 10 Yes No Spain 9 No No Turkey 10 Yes No USA 9 Yes Yes Venezuela 10 Yes No
6 Use of ICD-9-CM codes for Identification of Kidney Disease 136 codes related to kidney disease in ICD-9-CM Category Number Examples CKD 5 Chronic renal failure (585) AKD 6 Acute renal failure w lesion tubular necrosis (584.5) Damage 42 Proteinuria (791.0) Etiology 80 Membranous nephropathy (581.1) Complications 3 Renal osteodystrophy (588.9) Transplant 2 Status, post kidney transplant (v42.0) Dialysis 10 Renal dialysis status (v45.1) Risk factors many Diabetes
7 Frequency of Occurrence of CKD codes in the 5% Medicare sample claims set (2004) ICD9 Code Description Count Percent 585 Chronic renal failure % 588 Disorders resulting from impaired renal function % 584 Acute renal failure % 403.x1 Hypertensive renal disease with renal failure % 586 Renal failure, unspecified % Diabetes with renal manifestations % 591 Hydronephrosis % Malignant neoplasm of kidney % 583 Nephritis & nephropathy, not specified as acute % Atherosclerosis of renal artery % A.Collins.. USRDS Unpublished data
8 Counts of patients with diabetes & HTN in the Medicare & EGHP CKD populations Figure 1.1 Medicare: general Medicare CKD patients continuously enrolled in Medicare Parts A & B in 2004; patients enrolled in an HMO or diagnosed with ESRD during the year are excluded. EGHP: CKD patients continuously enrolled in a fee-for-serviceplan in ADR
9 Size of the CKD population (estimated from the 5% sample), by age & race Figure 1.6 general Medicare CKD patients continuously enrolled in Medicare Parts A & B for two consecutive years (numbers estimated from 5 percent sample); patients enrolled in an HMO or diagnosed with ESRD during the period are excluded ADR
10 NEW ICD-9-CM CODES FOR CKD Revise 585 Chronic renal failure Chronic kidney disease (CKD) New code Chronic kidney disease, Stage 1 New code Chronic kidney disease, Stage 2 (mild) New code Chronic kidney disease, Stage 3 (moderate) New code Chronic kidney disease, Stage 4 (severe) New code Chronic kidney disease, Stage 5 New code End stage renal disease New code Chronic kidney disease, unspecified Chronic renal disease Chronic renal failure NOS Chronic renal insufficiency Add status, if Use additional code to identify kidney transplant applicable (V42.0)
11 Diabetic Kidney Disease Non-Diabetic Kidney Disease Disease Type 1 Type 2 Glomerular Diseases Vascular diseases Stage & Tx 585.X (585.6 For ESRD) With V codes for D or T (v45.1, V42.0) CKD Classification Marker of Kidney Damage Proteinuria Proteinuria Hematuria +Proteinuria 599.7; Proteinuria Disease (ICD Code) 250.x1, 250.x3 250.x0, 250.x e.g. 443, , 447.3, Tubulointersitial Diseases +Pyuria, +Proteinuria, +Imaging studies * ; ; e.g. 590.xx Cystic diseases Cysts 753.1x Non-diabetic kidney disease not otherwise specified +Proteinuria V x Transplant +Proteinuria
12 WHO Family of Classifications RELATED Classifications International Classification of Primary Care (ICPC) International Classification of External Causes of Injury (ICECI) The Anatomical, Therapeutic, Chemical (ATC) classification system with Defined Daily Doses (DDD) ISO 9999 Technical aids for persons with disabilities Classification and Terminology REFERENCE Classifications I nternational C lassification of D iseases I nternational C lassification of F unctioning, Disability & Health I nternational C lassification of H ealth I nterventions (under development) DERIVED Classifications International Classification of Diseases for Oncology, Third Edition (ICD-O-3) The ICD-10 Classification of Mental and Behavioural Disorders Application of the International Classification of Diseases to Dentistry and Stomatology, Third Edition (ICD-DA) Application of the International Classification of Diseases to Neurology (ICD-10-NA) ICF, Children & Youth Version (ICF -CY) CLASSIFICATIONS BUILDING BLOCKS OF HEALTH INFORMATION
13 Maintenance of ICD Minor updates once a year: Spelling, clarifications, index entries Major updates every three years: Meaning of category Deletion or addition of category» J09 avian flu Revision every CLASSIFICATIONS BUILDING BLOCKS OF HEALTH INFORMATION
14 ICD Revisions Interval (years) ICD-1 ICD-2 ICD-3 ICD-4 ICD-5 ICD-6 ICD-7 ICD-8 ICD-9 ICD-10 ICD CLASSIFICATIONS BUILDING BLOCKS OF HEALTH INFORMATION
15 Key Drivers Mandated by WHA and EB Respond to consumer-needs needs Keep up with new scientific knowledge Compatibility within the WHO-FIC members Usability within Health Information Systems CLASSIFICATIONS BUILDING BLOCKS OF HEALTH INFORMATION
16 Placing WHO Classifications ICD e-health Record Systems Mappings Terminologies ICF ICHI Classifications Population Health Births Deaths Diseases Disability Risk factors Clinical Decision Support Integration of care Outcome Billing Management Interventions Diagnosis assessment Administration Scheduling Resources Reporting Cost Needs Outcome CLASSIFICATIONS BUILDING BLOCKS OF HEALTH INFORMATION
17 The WHO-FIC Network of Collaborating Centres CLASSIFICATIONS BUILDING BLOCKS OF HEALTH INFORMATION
18 CLASSIFICATIONS BUILDING BLOCKS OF HEALTH INFORMATION
19 CLASSIFICATIONS BUILDING BLOCKS OF HEALTH INFORMATION
20 CLASSIFICATIONS BUILDING BLOCKS OF HEALTH INFORMATION
21 Clinical modifications N18.8 Sonstige chronische Niereninsuffizienz N18.80 Einseitige chronische Nierenfunktionsstörung N18.81 Chronische Niereninsuffizienz, Stadium I; N18.82 Chronische Niereninsuffizienz, Stadium II; N18.83 Chronische Niereninsuffizienz, Stadium III; N18.84 Chronische Niereninsuffizienz, Stadium IV N18.89 Chronische nicht-terminale Niereninsuffizienz, Stadium nicht näher bezeichnet CLASSIFICATIONS BUILDING BLOCKS OF HEALTH INFORMATION
22 Classifications of CKD Severity (stage) Treatment (HD vs. PD) Diagnosis (cause) Prognosis (progression, CVD)
23 Proposed Next Steps Develop consensus within international nephrology community for kidney disease related recommendations for updates or revisions to ICD-10. Recommendations should include: CKD Modifications to ICD-9-CM Improved codes for markers of kidney damage and type of kidney disease Within individual countries, work with clinicians and coders to use ICD codes to classify CKD by severity, treatment, and diagnosis
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