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Query check CCI ICD10 Dialysis no Dx: Difference between revisions

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If there is a [[TISS28]] entry for Hemodialysis there should be a corresponding Dx.
{{Data Integrity Check
*32 Intermittent Hemodialysis (even if pt goes to dialysis unit)
|DIC_summary=If a profile has one of the [[#Dialysis CCI Items]] there should also be one of the [[#Dialysis qualifying Dxs]].
*33 CRRT
|DIC_related_concepts= Peritoneal dialysis (TISS Item); CRRT (TISS Item); Intermittent hemodialysis (TISS Item); {{#ask: [[Concept:Acute renal failure]]|default=none found|format=plainlist|link=none|limit=100|sep=;}}; Kidney, acute renal failure, postprocedural;Kidney, acute renal failure NOS;Kidney, acute tubular necrosis (ATN);Hyperkalemia;Congestive heart failure with pulmonary edema;Fluid overload;Acidosis, NOS;Kidney, renal tubular acidosis (RTA, all types);Aspirin or other salicylate or NSAID, overdose/toxicity;Antiseizure drug NOS, overdose/toxicity; Insulin or other antidiabetes drug, overdose/toxicity;Psychiatric drug NOS, overdose/toxicity;Drug or biological substance/agent NOS, overdose/toxicity;Alcohol (ethanol), poisoning;Toxic alcohols, poisoning;Calcium channel blocker, overdose/toxicity
*34 Peritoneal Dialysis
|DIC_firmness=hard check
|DIC_timing=complete
|DIC_coding=query ''check_CCI_ICD10_Dialysis_no_Dx''
|DIC_implementation_date=2021-10-27
|DIC_status=implemented
|DIC_app=CCMDB.accdb
}}


== CRF/ARF vs [[TISS28]] items 32, 33, 34 ==
If a profile has one of the [[#Dialysis CCI Items]] there should also be one of the [[#Dialysis qualifying Dxs]].
=== Has ARF/CRF but not Dialysis ===
If meets following the entry is an error:
* ICU patient
* LOS>3
* at least one of dxs ([ARF (Diagnosis)]](350), [[CRF - Chronic Renal Failure]](351)
* '''doesn't have''' one of (T32/33/34) in TISS28


=== TISS implies dx ===
=== Dialysis CCI Items ===
If meets following the entry is an error:
*{{ CCIWithCode | CRRT (TISS Item)}}
* ICU patient
*{{ CCIWithCode | Peritoneal dialysis (TISS Item)}}
* LOS>3
*{{ CCIWithCode | Intermittent hemodialysis (TISS Item)}}
* at least one of (T32/33/34) in TISS28
*{{ CCIWithCode | PD (Peritoneal dialysis)}}
* '''doesn't have''' one of dxs ([ARF (Diagnosis)]](350), [[CRF - Chronic Renal Failure]](351), [[Pt Monitored while on Dialysis]] (398),
*{{ CCIWithCode | HD (Hemodialysis)}}
*{{ CCIWithCode | CRRT (incl volume removal via PRISMA device)}}


== Reality check ==
=== Dialysis qualifying Dxs ===
{{discussion}}
*{{ICD10WithCode | Chronic kidney disease (chronic renal insufficiency, uremia) Stage 1, GFR GT 90}}
* Collectors can you see a scenario where this would not be an error? If not, this could be added to [[Change Priorities]]. Ttenbergen 20:17, 2014 April 30 (CDT){{Potential Change}}
*{{ICD10WithCode | Chronic kidney disease (chronic renal insufficiency, uremia) Stage 2, GFR 60-89}}
**codes 350 through 355 all pertain to ARF, however the other remaining codes are not correct, as they do not necessarily mean that dialysis is started [[User:Lkaita|Lisa Kaita]] 12:03, 2017 April 25 (CDT)
*{{ICD10WithCode | Chronic kidney disease (chronic renal insufficiency, uremia) Stage 3, GFR 30-59}}
*** So there are codes that ''might'' have dialysis, and codes that ''would'' have dialysis, right? I updated the two listings above. If pt has a dialysis-mandatory dx, must have TISS. If a pt has TISS, must have a dialysis-optional dx. Does the list of dxs in each case look right now? And, can you think of scenarios where these errors would lead to false positives? Ttenbergen 17:12, 2017 April 26 (CDT)
*{{ICD10WithCode | Chronic kidney disease (chronic renal insufficiency, uremia) Stage 4, GFR 15-29}}
*{{ICD10WithCode | Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15}}
*{{ICD10WithCode | Chronic kidney/renal disease, NOS (stage unspecified)}}
*{{ICD10WithCode | Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronic}}
*{{ICD10WithCode | Kidney, acute renal failure, postprocedural}}
*{{ICD10WithCode | Kidney, acute renal failure NOS}}
*{{ICD10WithCode | Kidney, acute tubular necrosis (ATN)}}
*{{ICD10WithCode | Hyperkalemia}}
*{{ICD10WithCode | Congestive heart failure with pulmonary edema}}
*{{ICD10WithCode | Fluid overload}}
*Metabolic acidosis:  
**{{ICD10WithCode | Acidosis, NOS}}
**{{ICD10WithCode | Kidney, renal tubular acidosis (RTA, all types)}}
*Drug overdoses and poisonings -- the main ones are:
** Aspirin & other salicylates -- {{ICD10WithCode | Aspirin or other salicylate or NSAID, overdose/toxicity}}
** Valproic acid, carbemazepine (Tegretol), phenytoin (Dilantin), barbiturates -- {{ICD10WithCode | Antiseizure drug NOS, overdose/toxicity}}
** Metformin -- {{ICD10WithCode | Insulin or other antidiabetes drug, overdose/toxicity}}
** Lithium -- {{ICD10WithCode | Psychiatric drug NOS, overdose/toxicity}}
** Theophylline -- {{ICD10WithCode | Drug or biological substance/agent NOS, overdose/toxicity}}
** Alcohols --  
*** {{ICD10WithCode | Alcohol (ethanol), poisoning}}
*** {{ICD10WithCode | Toxic alcohols, poisoning}}
** Diltiazem -- {{ICD10WithCode | Calcium channel blocker, overdose/toxicity}}
** Occasionally a few others (rare)


== Short stay patients, incl community hospitals==
Allan confirmed that we would not need to add covid because if used in that context, renal failure would also be coded.
CRF/ARF patients may not receive dialysis if they are only there for a short time. That led to false=positives for the check, especially in community hospitals, so the restriction of "LOS>3" was added.  


== Log ==
* 2024-04-24 - changed from [[Psychiatric drug NOS, adverse effect]] to [[Psychiatric drug NOS, overdose/toxicity]] [[User:Ttenbergen|Ttenbergen]] 09:50, 2024 April 24 (CDT)


[[Category: TISS28 Checks]]
== Related articles ==
{{Related Articles}}
 
[[Category:TISS28 check]]
[[Category:ICD10 Dx check]]
[[Category:Dialysis]]
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