I13.11
BillableHypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
HCC Category Mapping
What This Code Means
This code describes a patient who has high blood pressure affecting both the heart and kidneys, with the kidneys in their most severe stage of disease (stage 5/end-stage renal disease), but without heart failure. The patient's kidneys are functioning at less than 15% of normal capacity and typically requires dialysis or transplant.
Coding Tips
- •Verify documentation confirms both hypertensive heart disease AND chronic kidney disease stage 5/ESRD are present; do not use this code if heart failure is documented
- •Confirm the specific stage of CKD (stage 5 or ESRD) is documented; if stage 1-4 is present instead, use a different I13 code variant
Clinical Significance
This combination code captures hypertensive heart disease and advanced chronic kidney disease (stage 5 or ESRD) without heart failure. It represents a complex clinical scenario with significant renal impairment requiring dialysis or transplant consideration. The advanced CKD component drives substantial risk adjustment value, making accurate documentation and coding critical.
Documentation Requirements
- ✓Documented diagnosis of hypertension
- ✓Documented heart disease without heart failure
- ✓Documented chronic kidney disease stage 5 or end-stage renal disease
- ✓Additional code N18.5 (stage 5) or N18.6 (ESRD) required
- ✓Current eGFR < 15 mL/min to support stage 5 classification
- ✓Dialysis status if applicable (Z99.2)
- ✓Kidney transplant status if applicable (Z94.0)
- ✓Cardiac evaluation results showing structural heart disease
- ✓Confirmation that heart failure is NOT present