Renal Transplant: Difference between revisions

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{{DX tag | Renal | | Renal Transplant Surgery | |

{{DX tag | Renal | Surgical Problem | Renal Transplant Surgery | |

* 80500 - Renal Transplant Surgery

* 80501 - Removal of Transplant-Organ

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''For problems with kidney transplants, see [[Renal Transplant Problems]].

~~=== Raw content from [[HSC Medicine Collection Guide]] ===~~

This code (80503 - Rejection) is for the reason for surgery; see [[Renal Transplant Problems | 36101 - Renal Transplant Problems - Rejection ]] for the medical problem.

~~''''' I moved~~ the ~~following here from~~ [[~~HSC Medicine Collection Guide~~]] to make sure there is no inconsistent information in different places. If Julie uses this data we need to be sure that the instructions used in collecting it can be found in only one place. Chances are this information is already represented in the ~~sections below, it would good if someone who actually collects this could make sure that those sections are correct and comprehensive, and then get rid of this section~~. ~~Let me know if you would like help with that. If no one gets to it I will give it a shot next time I come across this. Ttenbergen 10:21, 2013 August 8 (CDT)~~

* Patient Type (Registry): Surgical

* Admit diagnosis:[[Pre OP admission-other]]

* Admit diagnosis:Pre-~~Optimization-893~~

* Acquired diagnosis '''can not be both''':

* ~~Complication is~~ '''~~only one of~~''':

**Renal Transplant-living donor - 80504

**Renal Transplant-living donor-~~805-04~~

**Renal Transplant-Cadaver donor - 80505

**Renal Transplant-Cadaver donor-~~805-05~~

*See [[Renal Coding Considerations (old)]]

*See [[Renal Coding Considerations]]

*usually patients are admitted from their home.If the recipient patient is not living in Winnipeg and is receiving a cadaveric donor kidney they may be instructed to go to their nearest hospital and arrangements will be made to transport them to HSC.

*The living donor recipients are scheduled by the renal clinic.The clinic will forward this information the week prior to surgery with the names of both the donor and recipient~~.Living renal transplants are performed on Thursdays and the patients are admitted Wednesday afternoon~~.

*The living donor recipients are scheduled by the renal clinic.The clinic will forward this information the week prior to surgery with the names of both the donor and recipient.

*Usually these patients have a co-morbidity of chronic renal failure. These patients are treated with routine hemodialysis or peritoneal dialysis. Occasionally the patient may receive a transplant before needing dialysis. If a pt has never received routine dialysis in the past, that pt is coded as chronic renal insufficiency mild or moderate depending on their creatinine.

*Once the patient has received a successful renal transplant and is discharged from the hospital,the next time they are admitted to hospital chronic renal failure will not be captured as a co-morbidity unless the transplanted kidney fails to function and dialysis is started again.

*Immune compromised renal transplants very occasionally become CMV+ or EBV+. This occurs when the donor is positive for CMV or EBV and the recipient was negative.The blood test is done by the Cadham Lab. The nephrologist will document this in the history or progress notes. The transplant recipient will be started on anti-viral medications approximately one week post-op and will continue these medications for six months and in conjunction their immune suppression drug dosage will be titrated lower.

**(Are we are collecting or keeping track of when a pt becomes CMV or EBV pos. post transplant? If ~~we are, this information would take more than six months to collect. I have not been following pts this long. Judy)~~

*If a renal transplant fails you might be able to code one of the following:

*** Collect it if it's in the chart, e.g. on a subsequent admission. Julie links data behind the scenes. You would not keep the patient on your laptop after discharge. Hope that is what you meant, if not please clarify.Ttenbergen 17:12, 2013 August 15 (CDT)Thanks for this infor Tina. It clears up my question. (Judy)

*ADL's are to reflect the patient's level of independence prior to surgery (home).

*N.B Chronic renal ~~failure patients who receive a~~ transplant ~~that is not successful,cannot have acute renal failure as an acquired diagnosis for our medical collection data program.This~~ might be ~~captured as delayed graft function/renal transplant problems other,or sometimes it is related~~ to ~~acute tubular necrosis and can be proven by renal biopsy. Other problems will be documented by~~ the ~~Nephrologists. Some problems are~~:

**[[ARI]] (364-00)

**[[Acute Tubular Necrosis]] (352-00)

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== Coding during the admission where transplant occurs ==

=== Renal Transplant Patient coding process ===

* ~~Patient~~ Type ~~(Registry)~~: ~~Surgical~~

* [[Admit Type for APACHE II]]: Elective Surgery

* ~~Apache Type~~: ~~Elective Surgery~~

* [[Previous Service]]: Not applicable if coming from home, Urology surgery if coming from the OR or PACU

* Admit DX: Pre-op Optimization - 893

* Complication is '''only one of''':

** Renal Transplant – '''living donor''' – 805-04

** [[Renal Transplant]] – '''living donor''' – 805-04

** Renal Transplant – '''Cadaver donor''' 805-05

** [[Renal Transplant]] – '''Cadaver donor''' 805-05

==== Discussion ====

The following questions relate to improvements of the renal coding error checks. We need answers, and they need to stay on this page, if I am to put the internal consistency checks in place. Ttenbergen 14:46, 2013 January 31 (EST)

++Discussion++

* Is the complication for organ source mandatory? Should there be a check for it? [[User:Ttenbergen|Ttenbergen]] 16:56, 3 September 2009 (CDT)

** as per Fran/Gail: "Yes and it gets coded under renal transplant surgery"

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moved to [[Dialysis_Tasks#Change_of_Dialysis_status_during_admission_-_Chronic_or_Acute.3F]] (delete this in a week)[[User:Ttenbergen|Ttenbergen]] 15:35, 14 September 2009 (CDT)

== {{Data Integrity Checks}} ==

== CMV+ or EBV+ prophylactic treatments ==

There are a number of coding rules related to renal diagnoses, centralized info about them is in [[Renal Coding Considerations]].

When a donor is found to be CMV+ or EBV+ the recipient will often prophylactically be put on antiviral medication. '''This does not mean the recipient is, or should be coded as, CMV+ or EBV+. Code only based on positive tests.

== Data Integrity Checks ==

There are a number of coding rules related to renal diagnoses, centralized info about them is in [[Renal Coding Considerations (old)]].

== Related Articles ==

see [[:Category:Renal Problem]] for other renal problems

see [[:Category:Renal Problem (old)]] for other renal problems

[[Category:Renal Problem]]

[[Category:Renal Problem (old)]]

~~[[Category:Diagnosis Coding~~]]

[[Category:Renal Surgery (old)]]

[[Category:Renal Surgery]]

@@ Line 1: / Line 1: @@
-{{DX tag | Renal | | Renal Transplant Surgery | |
+{{DX tag | Renal |  Surgical Problem | Renal Transplant Surgery | |
 * 80500 - Renal Transplant Surgery
 * 80501 - Removal of Transplant-Organ
@@ Line 10: / Line 10: @@
 ''For problems with kidney transplants, see [[Renal Transplant Problems]].
-=== Raw content from [[HSC Medicine Collection Guide]] ===
+This code (80503 - Rejection) is for the reason for surgery; see [[Renal Transplant Problems | 36101 - Renal Transplant Problems - Rejection ]] for the medical problem.
-''''' I moved the following here from [[HSC Medicine Collection Guide]] to make sure there is no inconsistent information in different places. If Julie uses this data we need to be sure that the instructions used in collecting it can be found in only one place. Chances are this information is already represented in the sections below, it would good if someone who actually collects this could make sure that those sections are correct and comprehensive, and then get rid of this section. Let me know if you would like help with that. If no one gets to it I will give it a shot next time I come across this. Ttenbergen 10:21, 2013 August 8 (CDT)
-* Patient Type (Registry): Surgical
+* Admit diagnosis:[[Pre OP admission-other]]
-* Admit diagnosis:Pre-Optimization-893
+* Acquired diagnosis '''can not be both''':
-* Complication is '''only one of''':
+**Renal Transplant-living donor - 80504
-**Renal Transplant-living donor-805-04
+**Renal Transplant-Cadaver donor - 80505
-**Renal Transplant-Cadaver donor-805-05
+*See  [[Renal Coding Considerations (old)]]
-*See  [[Renal Coding Considerations]]
 *usually patients are admitted from their home.If the recipient patient is not living in Winnipeg and is receiving a cadaveric donor kidney they may be instructed to go to their nearest hospital and arrangements will be made to transport them to HSC.
-*The living donor recipients are scheduled by the renal clinic.The clinic will forward this information the week prior to surgery with the names of both the donor and recipient.Living renal transplants are performed on Thursdays and the patients are admitted Wednesday afternoon.
+*The living donor recipients are scheduled by the renal clinic.The clinic will forward this information the week prior to surgery with the names of both the donor and recipient.
 *Usually these patients have a co-morbidity of chronic renal failure. These patients are treated with routine hemodialysis or peritoneal dialysis. Occasionally the patient may receive a transplant before needing dialysis. If a pt has never received routine dialysis in the past, that pt is coded as chronic renal insufficiency mild or moderate depending on their creatinine.
 *Once the patient has received a successful renal transplant and is discharged from the hospital,the next time they are admitted to hospital chronic renal failure will not be captured as a co-morbidity unless the transplanted kidney fails to function and dialysis is started again.
-*Immune compromised renal transplants very occasionally become CMV+ or EBV+. This occurs when the donor is positive for CMV or EBV and the recipient was negative.The blood test is done by the Cadham Lab. The nephrologist will document this in the history or progress notes. The transplant recipient will be started on anti-viral medications approximately one week post-op and will continue these medications for six months and in conjunction their immune suppression drug dosage will be titrated lower.
-**(Are we are collecting or keeping track of when a pt becomes CMV or EBV pos. post transplant?  If we are, this information would take more than six months to collect.  I have not been following pts this long. Judy)
+*If a renal transplant fails you might be able to code one of the following:
-*** Collect it if it's in the chart, e.g. on a subsequent admission. Julie links data behind the scenes. You would not keep the patient on your laptop after discharge. Hope that is what you meant, if not please clarify.Ttenbergen 17:12, 2013 August 15 (CDT)Thanks for this infor Tina.  It clears up my question. (Judy)
-*ADL's are to reflect the patient's level of independence prior to surgery (home).
-*N.B Chronic renal failure patients who receive a transplant that is not successful,cannot have acute renal failure as an acquired diagnosis for our medical collection data program.This might be captured as delayed graft function/renal transplant problems other,or sometimes it is related to acute tubular necrosis and can be proven by renal biopsy. Other problems will be documented by the Nephrologists. Some problems are:
 **[[ARI]]  (364-00)
 **[[Acute Tubular Necrosis]]  (352-00)
@@ Line 33: / Line 29: @@
 == Coding during the admission where transplant occurs ==
 === Renal Transplant Patient coding process ===
-* Patient Type (Registry): Surgical
+* [[Admit Type for APACHE II]]: Elective Surgery
-* Apache Type: Elective Surgery
+* [[Previous Service]]: Not applicable if coming from home, Urology surgery if coming from the OR or PACU
 * Admit DX: Pre-op Optimization - 893
 * Complication is '''only one of''':
-** Renal Transplant – '''living donor''' – 805-04
+** [[Renal Transplant]] – '''living donor''' – 805-04
-** Renal Transplant – '''Cadaver donor''' 805-05
+** [[Renal Transplant]] – '''Cadaver donor''' 805-05
 ==== Discussion ====
 The following questions relate to improvements of the renal coding error checks. We need answers, and they need to stay on this page, if I am to put the internal consistency checks in place. Ttenbergen 14:46, 2013 January 31 (EST)
-{{Discussion}}
+++Discussion++
 * Is the complication for organ source mandatory? Should there be a check for it? [[User:Ttenbergen|Ttenbergen]] 16:56, 3 September 2009 (CDT)
 ** as per Fran/Gail: "Yes and it gets coded under renal transplant surgery"
@@ Line 69: / Line 65: @@
 moved to [[Dialysis_Tasks#Change_of_Dialysis_status_during_admission_-_Chronic_or_Acute.3F]] (delete this in a week)[[User:Ttenbergen|Ttenbergen]] 15:35, 14 September 2009 (CDT)
-== {{Data Integrity Checks}} ==
+== CMV+ or EBV+ prophylactic treatments ==
-There are a number of coding rules related to renal diagnoses, centralized info about them is in [[Renal Coding Considerations]].
+When a donor is found to be CMV+ or EBV+ the recipient will often prophylactically be put on antiviral medication. '''This does not mean the recipient is, or should be coded as, CMV+ or EBV+. Code only based on positive tests.
+== Data Integrity Checks ==
+There are a number of coding rules related to renal diagnoses, centralized info about them is in [[Renal Coding Considerations (old)]].
+{{Data Integrity Check List}}
 == Related Articles ==
-see [[:Category:Renal Problem]] for other renal problems
+see [[:Category:Renal Problem (old)]] for other renal problems
-[[Category:Renal Problem]]
+[[Category:Renal Problem (old)]]
-[[Category:Diagnosis Coding]]
+[[Category:Renal Surgery (old)]]
-[[Category:Renal Surgery]]