ICD-9-CM Official Guidelines for Coding and Reporting - Office of ...

assigned if the patient has systolic or diastolic failure and
congestive heart failure.
The same heart conditions (425.8, 429.0-429.3, 429.8, 429.9)
with hypertension, but without a stated causal relationship, are
coded separately. Sequence according to the circumstances of
the admission/encounter.
3) Hypertensive Chronic Kidney Disease
Assign codes from category 403, Hypertensive chronic kidney
disease, when conditions classified to category 585 are present.
Unlike hypertension with heart disease, ICD-9-CM presumes a
cause-and-effect relationship and classifies chronic kidney
disease (CKD) with hypertension as hypertensive chronic
kidney disease.
Fifth digits for category 403 should be assigned as follows:
• 0 with CKD stage I through stage IV, or unspecified.
• 1 with CKD stage V or end stage renal disease.
The appropriate code from category 585, Chronic kidney
disease, should be used as a secondary code with a code
from category 403 to identify the stage of chronic kidney
disease.
See Section I.C.10.a for information on the coding of chronic
kidney disease.
4) Hypertensive Heart and Chronic Kidney Disease
Assign codes from combination category 404, Hypertensive
heart and chronic kidney disease, when both hypertensive
kidney disease and hypertensive heart disease are stated in the
diagnosis. Assume a relationship between the hypertension
and the chronic kidney disease, whether or not the condition is
so designated. Assign an additional code from category 428, to
identify the type of heart failure. More than one code from
category 428 may be assigned if the patient has systolic or
diastolic failure and congestive heart failure.
Fifth digits for category 404 should be assigned as follows:
• 0 without heart failure and with chronic kidney disease
(CKD) stage I through stage IV, or unspecified
• 1 with heart failure and with CKD stage I through stage
IV, or unspecified
• 2 without heart failure and with CKD stage V or end
stage renal disease
ICD-9-CM Official Guidelines for Coding and Reporting
Effective October 1, 2008
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