How to Code HTN, DM, CHF & CKD

• Ann Giles

How to Code HTN, DM, CHF & CKD


Mr. Jones presents to home health following a hospitalization for CHF exacerbation. His home Lasix dosage has been doubled. His medical history includes HTN, chronic systolic heart failure, DM and CKD stage 3.  How would you code this?

M1021a: I13.0 - Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
M1023b: I50.22 - Chronic systolic (congestive) heart failure
M1023c: E11.22 - Type 2 diabetes mellitus with diabetic chronic kidney disease
M1023d: N18.3 - Chronic kidney disease, stage 3 (moderate)


These 4 diagnoses must be “grouped” together and the sequencing guidance for each code must be followed. You will find a “use additional code” notes in the tabular index when you look at I13.0 and E11.22. You will also find a “code first” note when you look up I50.22 and N18.3 in the tabular index. Let’s take a look at what the official coding guidelines say about these notes: “Code first” and “Use additional code” notes are also used as sequencing rules in the classification for certain codes that are not part of an etiology/ manifestation combination.” 

So let’s look at all of the rules that must be followed and the possible sequencing:

  • I13.- must be coded before the I50.22
  • E11.22 must be coded before the N18.3
  • N18.3 & I50.22 must be coded after the I13.-

Following these rules, there are a few ways to sequence this properly:

  • I13.0, I50.22, E11.22, N18.3
  • I13.0, E11.22, I50.22, N18.3
  • I13.0, E11.22, N18.3, I50.22
  • E11.22, I13.0, I50.22, N18.3
  • E11.22, I13.0, N18.3, I50.22 

All of the above sequencing options are correct because they follow the “code first” and “use additional code” rules. In our scenario though, the CHF is the focus of care. Although CHF is the primary focus of care, I13.0 must be “coded first”. Because the CHF is primary focus of care, I13.0 and I50.22 are sequenced first to reflect the CHF requiring more care than the DM and CKD.

Ann Giles, RN, BSN, HCS-D, COS-C

Director of Coding & OASIS Review

A native of La Place, LA, Ann joined PPS Plus after earning her degree from Louisiana State University. She contributes her expertise and nursing experience in developing the thousands of alerts within OASIS Analysis Plus. When not submerged in her coding, Ann loves to submerge herself in tropical waters for some scuba diving and spearfishing with her husband, Ryan.