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January 29, 2020

The Link Between Diabetes and Kidney Disease

Diabetes is the leading cause of kidney disease. Furthermore, both of these conditions are among the top 10 leading causes of death in the United States. Diabetes comes in at #7 while kidney disease ranks closely at #9. According to the National Kidney Foundation, kidney disease kills more people than breast cancer or prostate cancer each year and affects more than 1 in 7 adults or about 15% of the U.S. population. With about 1 in 4 adult diabetics also suffering from kidney disease, the link between these two conditions is evident.


Healthy kidneys filter wastes and excess water out of the blood to create urine and to regulate blood pressure. With diabetes, the high blood sugar levels can cause the small blood vessels in the body to become damaged with plaque buildup. When the blood vessels in the kidneys are compromised, they can’t clean the blood properly. This can cause waste materials to build up. The body will also retain more water and salt than it should, which can result in weight gain and ankle swelling.


Likewise, the high blood glucose levels associated with diabetes may also cause damage to nerves in the body. This can cause difficulty in emptying the bladder. The pressure resulting from a full bladder can back up and injure the kidneys. Also, if urine remains in the bladder for a long time, an infection can develop from the rapid growth of bacteria in urine with a high sugar level.


Kidney damage caused by diabetes usually occurs slowly, over many years. Therefore, having diabetes for a longer time increases the chances of kidney damage. Damage is also more likely if your blood glucose is too high and/or your blood pressure is too high. According to the National Institutes of Health (NIH), African Americans, American Indians, and Hispanics/Latinos develop diabetes, kidney disease, and kidney failure at a higher rate than Caucasians.


Indications of Diabetic Kidney Disease

Most people with diabetic kidney disease do not have any signs or symptoms. For this reason, health care professionals will use blood and urine tests to check for diabetic kidney disease. One of the earliest signs of diabetic kidney disease is an increased excretion of albumin in the urine. If you have diabetes, make sure to have blood and urine tests done yearly and be aware of the following signs of kidney disease:

  1. Albumin/protein in the urine
  2. High blood pressure
  3. Ankle and leg swelling, leg cramps
  4. Going to the bathroom more often at night
  5. High levels of BUN and creatinine in blood
  6. Less need for insulin or antidiabetic medications
  7. Morning sickness, nausea and vomiting
  8. Weakness, paleness and anemia
  9. Itching

End stage renal (kidney) failure occurs when the kidneys function at only 10 to 15 percent. Three treatments are available at this advanced stage including hemodialysis, peritoneal dialysis, and kidney transplantation.


Risk Factors and How to Manage Them

The likelihood of developing kidney disease is greater if you have diabetes and:

  • high blood pressure
  • smoke
  • don’t follow your diabetes eating plan
  • eat foods high in salt
  • are not active
  • are overweight
  • have heart disease
  • have a family history of kidney failure

To prevent diabetes-related kidney damage, keep blood glucose and blood pressure at healthy levels. It is important to develop and maintain healthy lifestyle habits and take medications as prescribed in order to help to achieve these goals. Also, learn ways to cope with stress which will in turn lower your blood glucose and blood pressure. Try getting regular exercise, getting enough sleep, eating healthy and participating in relaxing activities.


Coding ICD-10-CM

There are combination codes in ICD-10-CM when documentation from the treating provider links these conditions. 


Type 1 Diabetes

Category E10 provides several options to report Type 1 diabetes mellitus with kidney complications:

E10.21

Type 1 diabetes mellitus with diabetic nephropathy

Type 1 diabetes mellitus with intercapillary glomerulosclerosis

Type 1 diabetes mellitus with intracapillary glomerulonephrosis

Type 1 diabetes mellitus with Kimmelstiel-Wilson disease

E10.22

Type 1 diabetes mellitus with diabetic chronic kidney disease

  • Use additional code to identify stage of chronic kidney disease (N18.1-N18.6)

E10.29

Type 1 diabetes mellitus with other diabetic kidney complication

Type 1 diabetes mellitus with renal tubular degeneration

Type 2 Diabetes

Category E11 provides several options as well to report kidney conditions and diabetes type 2:

E11.21

Type 2 diabetes mellitus with diabetic nephropathy

Type 2 diabetes mellitus with intercapillary glomerulosclerosis

Type 2 diabetes mellitus with intracapillary glomerulonephrosis

Type 2 diabetes mellitus with Kimmelstiel-Wilson disease

E11.22 

Type 2 diabetes mellitus with diabetic chronic kidney disease

  • Use additional code to identify stage of chronic kidney disease (N18.1-N18.6)

E11.29

Type 2 diabetes mellitus with other diabetic kidney complication

Type 2 diabetes mellitus with renal tubular degeneration

The Coding Guidelines reminds coders:

  • That the type of diabetes (type 1 versus type 2) is not related to the age of a patient and age is not the sole determining factor, though most type 1 diabetics develop the condition before reaching puberty. For this reason, type 1 diabetes mellitus is also referred to as juvenile diabetes.  When the type of diabetes mellitus not documented in the medical record, the default is E11.-, Type 2 diabetes mellitus.

Insulin is always prescribed to treat Type 1 diabetes. However, insulin can also be part of the treatment plan for type 2 diabetics, therefore:

  • If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code E11-, Type 2 diabetes mellitus, should be assigned.
  • An additional code should be assigned from category Z79 to identify the long-term (current) use of insulin or oral hypoglycemic drugs. If the patient is treated with both oral medications and insulin, only the code for long-term (current) use of insulin should be assigned. Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter.

Conclusion

Chronic kidney disease “is the under-recognized public health crisis,“ according to the National Kidney Foundation. With diabetes being the leading cause of this disease, it is important to recognize the impact both of these conditions are having on the population. Continue following our diabetes blog series to learn more about its link to other conditions. Also, remember to watch out for our upcoming course Key to ICD-10-CM Compliance – Coding Diabetes.

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