Kidney, acute tubular necrosis (ATN): Difference between revisions
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*Common causes of ATN include shock, and nephrotoxic drugs. | *Common causes of ATN include shock, and nephrotoxic drugs. | ||
*ATN is a diagnosis ''usually'' made clinically by: presence of AKI + presence of a known cause of ATN + urine electrolytes showing consistent findings (e.g. fractional excretion of sodium of >1%) + urine sediment showing lots of renal tubular epithelial cells. | *ATN is a diagnosis ''usually'' made clinically by: presence of AKI + presence of a known cause of ATN + urine electrolytes showing consistent findings (e.g. fractional excretion of sodium of >1%) + urine sediment showing lots of renal tubular epithelial cells. | ||
*If you use this code, there is no absolute requirement to also code one of the AKI/ARF codes, though you can if you want to. | *If you use this code, there is no absolute requirement to also code one of the AKI/ARF codes, though you can if you want to -- and if you do choose to do so you should combine it with the AKI/ARF code. | ||
{{ICD10 Guideline ESRD vs Acute renal failure}} | {{ICD10 Guideline ESRD vs Acute renal failure}} | ||
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** What is special about this dx that would have you not code it? Is it that you are wondering whether coding a CCI means you don't have to code a dx? They are different things, you would still need to code the dx. Am I misunderstanding the question? Ttenbergen 07:09, 2018 December 14 (CST) | ** What is special about this dx that would have you not code it? Is it that you are wondering whether coding a CCI means you don't have to code a dx? They are different things, you would still need to code the dx. Am I misunderstanding the question? Ttenbergen 07:09, 2018 December 14 (CST) | ||
}} | }} | ||
== Alternate ICD10s to consider coding instead or in addition == | == Alternate ICD10s to consider coding instead or in addition == | ||
{{ListICD10Category | categoryName = Renal failure}} | {{ListICD10Category | categoryName = Renal failure}} | ||
Revision as of 14:51, 29 December 2018
| ICD10 Diagnosis | |
| Dx: | Kidney, acute tubular necrosis (ATN) |
| ICD10 code: | N17.0 |
| Pre-ICD10 counterpart: | Acute Tubular Necrosis (ATN) |
| Charlson/ALERT Scale: | none |
| APACHE Como Component: | none |
| APACHE Acute Component: | 2019-0: Renal/Metabolic NOS, 2019-0: Metabolic/Renal NOS |
| Start Date: | |
| Stop Date: | |
| Data Dependencies(Reports/Indicators/Data Elements): | No results |
| External ICD10 Documentation | |
This diagnosis is a part of ICD10 collection.
Additional Info
- Acute tubular necrosis (ATN) is a medical condition involving the death of tubular epithelial cells that form the renal tubules of the kidneys.
- It is one of many possible causes of acute kidney injury (AKI) -- also known as Acute Renal Failure. In the ICU it's among the most common causes of AKI.
- Common causes of ATN include shock, and nephrotoxic drugs.
- ATN is a diagnosis usually made clinically by: presence of AKI + presence of a known cause of ATN + urine electrolytes showing consistent findings (e.g. fractional excretion of sodium of >1%) + urine sediment showing lots of renal tubular epithelial cells.
- If you use this code, there is no absolute requirement to also code one of the AKI/ARF codes, though you can if you want to -- and if you do choose to do so you should combine it with the AKI/ARF code.
ESRD vs Acute Renal Failure
- AND
- UNLESS the patient has had a renal transplant and the transplanted kidney was functioning (and thus can experience acute renal failure)
About "Acute on Chronic renal failure"
- Our definition for CRF includes two things, as above. If you are on dialysis then it is technically not possible to also have acute renal failure. And while our threshold of creatinine clearance < 15 ml/min USUALLY gets people on dialysis, that's not always the case. In other words, there are some people who don't need to start dialysis until their clearance is <10 or even 8 ml/min. THOSE people who by our definition have Stage 5 CKD cannot have ARF but rather this is considered a progression of their underlying disease. Instead of coding ARF, code the reason for dialysis ie. Fluid overload, Hyperkalemia etc combined with Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15
- And of course, if you previously had Stage 5, were on dialysis, then got a successful renal transplant, then you CAN get acute renal failure in your graft.
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Alternate ICD10s to consider coding instead or in addition
| Renal failure codes: |
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 Checks (automatic list)
| App | Status | |
|---|---|---|
| Query check CCI ICD10 Dialysis no Dx | CCMDB.accdb | implemented |
| Query check_ICD10_ESRD_and_AKI_only_if_transplant | CCMDB.accdb | implemented |
| Query check ICD10 ESRD vs ARF | CCMDB.accdb | not feasible |
| Check CRF vs ARF across multiple encounters | Centralized data front end.accdb | declined |
Related CCI Codes
Data Integrity Checks (automatic list)
| App | Status | |
|---|---|---|
| Query check CCI ICD10 Dialysis no Dx | CCMDB.accdb | implemented |
| Query check_ICD10_ESRD_and_AKI_only_if_transplant | CCMDB.accdb | implemented |
| Query check ICD10 ESRD vs ARF | CCMDB.accdb | not feasible |
| Check CRF vs ARF across multiple encounters | Centralized data front end.accdb | declined |
Related Articles
Show all ICD10 Subcategories