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New ICD-9-CM Code for Beneficiaries with Chronic Kidney Disease
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MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Note: This article was revised on November 3, 2005, to reflect changes made to CR4108, which was revised by the Centers for Medicare & Medicaid Services (CMS) on October 31, 2005. The CR was revised to include new codes for EPO and Aranesp. The new codes are effective on January 1, 2006, and replace the current codes, which will terminate on January 1, 2006. |
Provider Types Affected
Providers billing Medicare fiscal intermediaries (FIs) for services provided to beneficiaries with chronic kidney disease
Provider Action Needed
Impact to You
This article is based on Change Request (CR) 4108, which announces that ICD-9-CM code 585 for Chronic Renal Failure will no longer be acceptable without the fourth-digit extension for claims with dates of service on or after October 1, 2005.
What You Need to Know
The ICD-9-CM diagnosis code 585 for chronic kidney disease has been extended to include a fourth digit to provide a higher degree of specificity in reporting the stage of kidney disease. The new ICD-CM codes are described in the table below:
What You Need to Do
See the Background section of this article for further details regarding the new ICD-9-CM codes for Medicare beneficiaries with chronic kidney disease.
Background
Transmittal# 591, Change Request 3888, issued on June 24, 2005, provided instructions for the annual update of the International Classification of Diseases, 9th Rev, Clinical Modification (ICD-9-CM) coding (effective on October 1, 2005). This annual update extends the diagnosis code of 585 for chronic kidney disease to include a fourth digit for a higher degree of specificity in reporting the stage of kidney disease.
Renal dialysis facilities, hospitals, and providers should be aware that the ICD-9-CM code 585 for Chronic Renal Failure will no longer be acceptable without the fourth-digit extension for claims with dates of service on or after October 1, 2005.
The new codes for chronic kidney disease are defined in the following table:
ICD-9-CM Diagnosis Code |
ICD-9-CM Diagnosis Code Description |
585.1 |
Chronic kidney disease, Stage I |
585.2 |
Chronic kidney disease, Stage II (mild) |
585.3 |
Chronic kidney disease, Stage III (moderate) |
585.4 |
Chronic kidney disease, Stage IV (severe) |
585.5 |
Chronic kidney disease, Stage V |
585.6 |
End stage renal disease |
585.9 |
Chronic kidney disease, unspecified |
Type of Bill (TOB) 72x
Renal Dialysis Facilities (RDFs) submitting claims with TOB 72x should report diagnosis code 585.6 (End Stage Renal Disease).
Note: The first two digits of the TOB 72X indicate a claim for an ESRD facility, and the third digit identifies the frequency of the claim being submitted. |
Epoetin Alfa and Darbepoetin Alfa
RDFs and hospitals billing for Epoetin Alfa (EPO) with Healthcare Common Procedure Coding System (HCPCS) code Q4055 and Darbepoetin Alfa (Aranesp) with HCPCS code Q4054 must have diagnosis code 585.6 (End Stage Renal Disease).
Epoetin Alfa (EPO), billed with HCPCS code Q0136, and Darbepoetin Alfa (Aranesp), billed with HCPCS code Q0137, are not appropriate for beneficiaries who have been diagnosed with end stage renal disease and, therefore, should not be billed in conjunction with the diagnosis code of 585.6 (End Stage Renal Disease).
Also, please note the change to the codes being used for EPO and Aranesp, since some codes are being terminated and replaced with new codes as of January 1, 2006. Those changes, effective January 1, 2006, are as follows:
- Q0136 – Epoetin Alfa for Non-ESRD use is replaced with J0885.
- Q0137 – Darbepoetin Alfa for Non-ESRD use is replaced with J0881.
- Q4054 – Darbepoetin Alfa for ESRD use is replaced with J0882.
- Q4055 – Epoetin Alfa for ESRD use is replaced with J0886.
Implementation
The implementation date for the instruction is April 3, 2006.
Additional Information
For complete details, please see the official instruction issued to your intermediary regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/Transmittals/  on the CMS Web site.
From that Web page, look for CR4108 in the CR NUM column on the right, and click on the file for that CR. For the annual ICD-9-CM update, look for CR 3888.
If you have any questions, please contact your intermediary at their toll-free number, which may be found at http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
For more information, visit the Medlearn Matters Web page at: http://www.cms.hhs.gov/MedlearnMattersArticles/.
Pub. 100-4, Transmittal# 737, CR# 4108
Medlearn Matters Number: MM4108 Revised
Related CR Release Date: October 31, 2005
Effective Date: October 1, 2005
Implementation Date: April 3, 2006
Posted: 11/15/2005
CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.
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