Chronic Kidney Disease

Patients with CKD or ESRD?*

The principle aim is to identify individuals at risk of progressive chronic kidney disease (CKD) in the primary care setting:

• Lab test to identify and monitor proteinuria, serum creatinine levels and hematuria

• Control the underlying disease if applicable, like hypertension or diabetes (DM)

• Assess for any urinary obstruction

• Medication review to identify nephrotoxic drugs and drugs that may need to be adjusted

• Assess for anemia, hemoglobin levels

• If progression is identified, it may be necessarily to refer the patient to a nephrologist

Same as above plus:

• Potassium, bicarbonate, calcium and phosphate levels

• Assess for water fluid retention

• If applicable, assess AV fistula/shunt site, use in addition code Z99.2

• Evaluate patient every 3 months

CKD 5 requiring dialysis is considered the end stage of the disease (ESRD). Use in addition code Z99.2 to identify patients requiring dialysis.

• Patients refusing dialysis, use code Z91.15

• Kidney transplant status, use code Z94.0

30 million people or 15% of adults in the U.S. are estimated to have CKD. Most (96%) people with kidney damage or mildly reduced kidney function are not aware of having CKD. Those with diabetes, high blood pressure, or both have a higher risk of developing CKD than those without these diseases. Other risk factors for CKD include heart disease, obesity, and a family history of CKD4

Patient with CKD may develop hyperparathyroidism. It is a very early disease and its diagnosis and treatment is crucial in the management of the patient. It has been demonstrated that the PTH starts to increase as early as the beginning of CKD stage 3, along with normal levels of serum calcium and phosphorus5

• Related to CKD or another renal disease, N25.81

• Due to other condition, E21.1

• Primary, E21.0

Patients who have undergone kidney transplant may still have some form of CKD3. Therefore, assign the appropriate N18 code for the patient’s stage of CKD and code Z94.0.

Monitor periodically these conditions and their plan of treatment. Some patients do not adhere to medications, diet or care plan. We recommend scheduling one face-to-face visit before July 1st, and one before December 31st.

References and Additional Notes:

* This tool is not intended to diagnose, evaluate or treat patients. Each provider is responsible for the clinical and diagnostic decisions pertinent to their patient’s medical care. ** CMS-HCC scores are based on CMS’ 2020 community-nondual-aged enrollees.

1. CDC. National Chronic Kidney Disease Fact Sheet, 2021. Excerpted: https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html

2. The Renal Association. The UK eCKD Guide. 2017. Excerpted: https://ukkidney.org/health-professionals/information-resources/uk-eckd-guide

3. RAF weight is based on a community-nondual-aged member, please refer to: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2019.pdf

4. CMS. ICD-10-CM Official Guidelines for Coding and Reporting FY 2021. Excerpted: https://www.cdc.gov/nchs/icd/data/10cmguidelines-FY2019-final.pdf