Bone mineral disease of CKD
Our team has been discussing how to code bone mineral disease of CKD in the absence of documentation of secondary osteodystrophy or hyperparathyroidism. Some feel it is appropriate to code E83.89 (Other disorders of mineral metabolism) and others feel a query is needed for documentation of renal osteodystrophy or secondary hyperparathyroidism.
According to KDIGO (Kidney Disease: Improving Global Outcomes) working group, BMD of CKD is a distinct term for a systemic disorder in bone metabolism in the setting of CKD, and is the recommended terminology. One of our clinical providers explained that renal osteodystrophy is technically only able to be diagnosed by bone biopsy so most providers don't use that terminology, and that secondary hyperparathyroidism is a part of CKD-BMD but does not describe the whole disorder.
I am curious how other organizations address this for accurate coding & compliance. DRG Expert index seems to support assigning E83.89 in the absence of documentation of either of the other associated secondary conditions (per Excludes note). If BMD of CKD is noted, would it be considered leading to query for secondary hyperparathyroidism or osteodystrophy? I can’t find any guidance in the Official Guidelines for Coding and Reporting FY2020 or Coding Clinics.
All insight is appreciated...thanks!