A Deeper Dive into the Code Changes for CKD Stage 3

The ICD-10-CM code for Chronic Kidney Disease (CKD) Stage 3 (N18.3) has been revised for Fiscal Year 2021. The most recent update to the CMS-HCC Risk Adjustment Model has CKD Stage 3 making an impact on Risk Adjustment Factor scores. On the other hand, CKD Stage 3 is not recognized as a complication or comorbidity (CC) in the DRG world of coding.

Not only do the new codes for CKD Stage 3 give more specificity and capture more detail, but they also help to define more precisely the edge within Stage 3 at which mortality becomes the main concern.

The new codes are as follows:

  • N18.30  CKD, Stage 3 unspecified
  • N18.31  CKD, Stage 3a (GFR = 45-59)
  • N18.32  CKD, Stage 3b (GFR= 30-44)

Kidney disease is often asymptomatic and occurs just before kidney failure. About one-third of the population of older adults have CKD Stage 3. When someone is experiencing Stage 3, it means their kidneys are filtering about half of what they should be, allowing for some fluids, electrolytes, and waste to build up in the body.

CKD often starts to develop without notice. However, symptoms may appear in Stage 3. For those that do experience symptoms, these may include fatigue, swelling around the ankles or eyes, unusually light-colored urine, urinating more frequently, and loss of appetite.

Once an individual has Stage 3 CKD, it’s generally considered to be irreversible. Fortunately, the majority of Stage 3 patients do not progress to the more severe stages. Still, it is important to work with a doctor to manage the condition and gain a clear picture in regard to the GFR and kidneys. This helps to identify the need for kidney replacement therapy sooner and essentially helps to keep the patient healthier longer.

References:

https://www.fairview.org/blog/A-Third-of-Older-Adults-have-Stage-3-Chronic-Kidney-Disease

https://academic.oup.com/ndt/article/22/9/2728/1842891

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