View source for Kidney, acute renal failure NOS

{{ICD10 transition status
| OldDxArticle = ARF; ARI
| CurrentStatus = needs review 
| InitialEditorAssigned = Michelle Lagadi
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{{ICD10 dx
| MinimumCombinedCodes =
| ICD10 Code=N17.9
| BugRequired= 
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{{ICD10 category|Renal/urinary}}{{ICD10 category|Renal failure}}

{{Discuss | who = all | question = 
* Patients are frequently admitted with AKI as part of dx list to medicine wards. To confirm, with the move to ICD 10 are kidney failure codes available options for use on all medicine wards? [[User:Ppiche|Pamela Piche]] 13:30, 2018 October 25 (CDT)
** Note, all the ICD10 diagnosis codes are available in both ICU and Medicine -- there seems to have been some confusion about differential availability of diagnosis codes in ICU and Medicine, and that is no longer the case in ICD10.
** This question doesn't relate to ICU/medicine collecting differences, but rather to the fact that the old renal failure code was meant to apply ONLY to those patients requiring dialysis. Different hospitals were not allowed to enter renal failure codes, because their peripheral hospitals did not have the capability of performing dialysis. We need to make it clear that this new ICD10 code no longer implies dialysis was initiated, unless the [[Renal dialysis care, including dialysis itself]] code is also used.
*** Good point. This is sort of similar to how some other dx definitions and codes have changed significantly over time. But now that you say it I sure would not be able to remember what these things were. I could set up another template for the wiki to tag these, something like <nowiki>{{SignificantChangeICD10CCI | one sentence for the change since all it needs to do is highlight this}}</nowiki>, and then have a central page to list all the pages that use the template, with that reason. And highlight it on the pages where it is written, sort of similar to the question boxes we have now. An advantage to doing this is that we could also disappear (or at least make less prominent) the template in a year or two, when this is no longer news. If we did this I would have to rely on you guys to actually place that template. If I get 2-3 volunteers then let's discuss further. Or, as a much smaller scale, we could put this on the agenda for the [[Team Meeting November 29, 2018]]. }}

== Additional Info ==
*Acute renal failure (of any cause) is an old term. Nephrologists want us to use the term Acute Kidney Injury (AKI).
**The reason is that this entity, whatever it's called, includes the full range of levels of kidney injury from minor all the way up to complete renal shutdown.  
**And yet another synonym is '''Acute Renal Insufficiency''' ([[ARI]]).
*For any/all causes of this entity, the [http://kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf KDIGO guidelines] identify that this is present if any one or more of the following are true:
**Increase in serum creatinine by 26 micromoles/L or more within 48 hours
**Increase in serum creatinine to 1.5 times baseline or more within the last 7 days 
**Urine output less than 0.5 mL/kg/hour for 6 hours
*This specific NOS code '''excludes: ''' [[Kidney, acute renal failure, postprocedural]]


{{DA| 
*I double checked with our lab values, and it looks like our EPR results are measured in micromoles/L.  Using the guidelines listed above, that would mean that any patient who has a rise in creatinine over a 2 day period equal or greater to 26, would be coded as "acute renal failure NOS". For example, a patient whose creatinine rises from 120 to 150 within 48 hours, would receive this code. I feel like I am reading these instructions wrong, because this would mean a large number of patients would fall into this category.[[User:Mlagadi|Mlagadi]] 14:01, 2018 October 16 (CDT)
** I'll leave this for Allan to confirm, but the definition on p.19 of [http://kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf KDIGO guidelines] does indeed say so, even though it uses the cut-off 26.5 and I am not sure why we would have deviated from that.
**AG REPLY -- yes this is correct.  Again the problem is that the term Acute Renal '''FAILURE''' suggests that severe renal injury is needed, and that's why the newer term AKI is better. }}

{{ICD10 Guideline ESRD vs Acute renal failure}}

== Alternate ICD10s to consider coding instead or in addition ==
{{ListICD10Category | categoryName = Renal failure}}
{{ListICD10Category | categoryName = Chronic kidney disease}}

== Candidate [[Combined ICD10 codes]] ==
*Also code the cause, if known.

== Data Integrity Checks ==
There are a number of coding rules related to renal diagnoses, centralized info about them is in '''[[Renal Coding Considerations for ICD10]]'''. 
{{Data Integrity Check List}}

== Related CCI Codes ==

== Legacy Info ==
We understand that the definition in the ICD10 codes is different than the definition in [[ARF (Diagnosis)]] and [[ARI]] and [[CRF - Chronic Renal Failure]] was. We are OK with that and will use the new definitions for the new codes, and the old ones for the old codes. Hopefully we can limit the amount of time where we consider both.

== Related Articles ==
{{Related Articles}}

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