Diagnosis Codes and Descriptions

ICD-10-CM code Description 

I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease 

I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease 

I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease 

N18.1 Chronic kidney disease, stage 1 N18.2 Chronic kidney disease, stage 2 (mild) 

N18.3 Chronic kidney disease, stage 3 (moderate) 

N18.4 Chronic kidney disease, stage 4 (severe)

N18.5 Chronic kidney disease, stage 5 

N18.6 End stage renal disease 

N18.9 Chronic kidney disease, unspecified

NOTE: If a patient had a kidney transplant that was successful, the patient no longer has chronic kidney failure, therefore it would be inappropriate for the provider to bill ICD-9- CM codes 585.1 - 585.6, 585.9 or, if ICD-10-CM is applicable, the diagnosis codes N18.1 - N18.9 on such a patient. In these cases one of the following codes should be present on the claim or in the beneficiary's history.

The provider uses the following ICD-9-CM status codes only when a kidney transplant was performed before the pancreas transplant and ICD-9 is applicable:

ICD-9- CM code Description 

V42.0 Organ or tissue replaced by transplant kidney

V43.89 Organ tissue replaced by other means, kidney or pancreas

Covered Conditions

Effective for services performed on or after April 28, 1989: 

For acute leukemia in remission for patients who have a high probability of relapse and who have no human leucocyte antigens (HLA)-matched, the following diagnosis codes are reported:

If ICD-9-CM is applicable, use the following Diagnosis Codes and Descriptions

Diagnosis Code Description 

204.01 Lymphoid leukemia, acute, in remission 

205.01 Myeloid leukemia, acute, in remission 

206.01 Monocytic leukemia, acute, in remission 

207.01 Acute erythremia and erythroleukemia, in remission 

208.01 Leukemia of unspecified cell type, acute, in remission

If ICD-10-CM is applicable, use the following Diagnosis Codes and Descriptions

C91.01 Acute lymphoblastic leukemia, in remission 

C92.01 Acute myeloblastic leukemia, in remission 

C92.41 Acute promyelocytic leukemia, in remission 

C92.51 Acute myelomonocytic leukemia, in remission 

C92.61 Acute myeloid leukemia with 11q23-abnormality in remission

C92.A1 Acute myeloid leukemia with multilineage dysplasia, in remission 

C93.01 Acute monoblastic/monocytic leukemia, in remission 

C94.01 Acute erythroid leukemia, in remission 

C94.21 Acute megakaryoblastic leukemia, in remission 

C94.41 Acute parmyelosis with myelofibrosis, in remission

C95.01 Acute leukemia of unspecified cell type, in remission

For resistant non-Hodgkin's lymphomas or those presenting with poor prognostic features following an initial response the following diagnosis codes are reported:

A/B MAC (A) Action

The contractor is responsible for the following:

• It accepts HCPCS codes for inpatient services; 

• It edits to require HCPCS codes with Revenue Code 0636. Multiple iterations of the revenue code are possible with the same or different HCPCS codes. It does not edit units except to ensure a numeric value;

• It reduces charges forwarded to Pricer by the charges for hemophilia clotting factors in revenue code 0636. It retains the charges and revenue and HCPCS codes for CWF; and 

• It modifies data entry screens to accept HCPCS codes for hospital (including CAH) swing bed, and SNF inpatient claims (bill types 11X, 12X, 18x, 21x and, 22x).

The September 1, 1993, IPPS final rule (58 FR 46304) states that payment will be made for the blood clotting factor only if diagnosis code for hemophilia is included on the bill. 

Inpatient blood-clotting factors are covered only for beneficiaries with hemophilia. One of the following hemophilia diagnosis codes must be reported on the claim for payment to be made for blood clotting factors.

ICD-9- CM code	Description
286.0	Congenital factor VIII disorder
286.1	Congenital factor IX disorder
286.2	Congenital factor XI deficiency
286.3	Congenital deficiency of other clotting factors
286.4	von Willebrands' disease

Effective for discharges August 1, 2001 through the implementation of ICD-10, payment may be made if a diagnosis codes from either Table 1 or Table 2 is reported is reported:

ICD-9- CM code	Description
286.5	Hemorrhagic disorder due to intrinsic circulating anticoagulants (terminate effective September 30, 2011)
286.7	Acquired coagulation factor deficiency