Health data standards and systems

On page 215 ACS 1438 Chronic kidney disease: Diabetic Nephropathy the following paragraph appears:

Diabetic nephropathy is also known as diabetic glomerulosclerosis. It is a common underlying condition for CKD. In this condition, the glomeruli of the kidney thicken reducing the ability of the glomeruli to filter the blood and allows more protein, in the form of albumin, into the urine. This is termed microalbuminuria and is one of the earliest markers of CKD (see also ACS 0401 Diabetes mellitus and impaired glucose regulation, page 93, Complications in diabetes and IGR, page 101, Kidney complications, page 103).

Nowhere in ACS 0401 Diabetes mellitus and impaired glucose regulation does it replicate this advice that diabetic nephropathy is also known as diabetic glomerulosclerosis, nor does it give you a specific code to assign for diabetic glomerulosclerosis NOS or diabetic nephropathy NOS anywhere in the index. (see below)

Index entries under:
Glomerulosclerosis (see also Sclerosis, kidney) N26
- with diabetes
- - diffuse E1-.22
- - intracapillary E1-.22
- - nodular E1-.22

Sclerosis, sclerotic
- kidney N26

Diabetes
- with
- - glomerulosclerosis
- - - with ESKD E1-.22
- - - diffuse E1-.22
- - - intracapillary E1-.22
- - - nodular E1-.22

Diabetes
- with
- - nephropathy E1-.22
- - - incipient E1-.21

Nephropathy (see also Nephritis) N28.9
- with
- - diabetes E1-.22

Nephritis, nephritic N05.-
- with
- - diabetes E1-.22

Is this statement on page 215 supposed to be instructing coders to assign N26 glomerulosclerosis where diabetic nephropathy is documented, instead of N28.9 Nephropathy NOS.

For example if a patient has DM, diabetic retinopathy, diabetic nephropathy and polyneuropathy (when DM meets ACS 0002 criteria and is therefore coded) are we supposed to assign:
E1-.71
H35.0 Retinopathy
N28.9 Nephropathy
G62.9 Polyneuropathy
or
E1-.71
H35.0 Retinopathy
N26 Glomerulosclerosis
G62.9 Polyneuropathy

Search Details: Raised at workshop - instructed to refer to state coding committee

VICC acknowledges that the paragraph on diabetic nephropathy in ACS 1438 Chronic kidney disease is not replicated in ACS 0401 Diabetes mellitus and impaired glucose regulation, however it is for information only and is not instructing coders to assign N26 Glomerulosclerosis for diabetic nephropathy. When applying a standard, code assignment should be based on the information in the classification boxes. In your example, if it is documented that the patient has nephropathy, assign N28.9. Coders should use the documentation in the medical record to follow the index and assign the appropriate code accordingly.