Kidney Transplant Coding Guidelines

Transplant failure or rejection or unspecified complication guideline

• This code includes transplant rejection, transplant failure (primary or subsequently), and others problems with the transplanted organ itself.
  • For example if the transplanted organ gets into trouble from Graft-versus-host disease/reaction (GVHD) then you should combine that code with this code.
• This code can be used for the whole range of problems with a transplanted organ -- of any severity (mild dysfunction up to total loss of the transplant) and of any duration (temporary or permanent).
• https://en.wikipedia.org/wiki/Transplant_rejection
• If you use this code, you should also code the relevant past history code for the transplant, if applicable, i.e. if the pt would have qualified for that code if the transplant had not failed.

Prophylactic treatment does not indicate infection ( CMV+ or EBV+ donors or recipients)

• We are NOT coding anything having to do with the Cytomegalovirus (CMV) or EBV or Mycobacterium Tuberculosis or Urinary tract infection, NOS or Hepatitis C, chronic status of the donor.
• Accordingly, do not code a transplant recipient as infected or colonized with such organisms, but of course DO code them as infected with them IF THEY BECOME INFECTED WITH THEM -- which is not indicated just by the recipient being prophylactically treated for them after the transplant.
• As per Colonized with organism (not infected), we are not tracking colonization with either of these viruses.

How past data was back populated

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(based on 27June2022 meeting of Allan and Julie, completed by Pagasa as per email from 2022-08-26) if an organ transplant failure or rejection code occurs in Admit, add this organ past history Transplant code in comorbid. if an organ transplant failure or rejection code occurs in Acquired, follow below: if there is a CCI code of transplant present (implying the transplant happens in this admission) or old coding of transplant present (prior Jan 1, 2019), then DO NOT enter this organ past history Transplant code in comorbid. if there is NO CCI code of transplant present (implying NO transplant happens in this admission) or NO old coding of transplant present (prior Jan 1, 2019), then enter this organ past history Transplant code in comorbid. if an organ transplant failure or rejection code occurs in Comorbid, add this organ past history Transplant code in comorbid. ICD10 Transplant Failure or rejection codes - T86.000 (bone marrow), T86.1 (kidney), T86.2 (heart), T86.3 (heart-lung), T86.4 (liver), T86.80 (lung), T86.81 (pancreas), T86.88 (NOS) ICD10 Past History Transplant - Z94.0(kidney), Z94.1(heart), Z94.2 (lung), Z94.4 (liver), Z94.80 (bone marrow) , Z94.82 (pancreas), Z94.88 (NOS) CCI Transplant codes - 1.WY.19 (Bone marrow), 1.PC.85 (kidney), 1.HZ.85 (heart), 1.OA.85 (liver), 1.GT.85 (lung), 1.OJ.85 (pancreas) Old Coding Dx transplant failed or rejection - 29.01 (post lung), 361.01 or 805.02 or 805.03 (Renal), 429.01 (liver), 430.01(pancreas).766.01 (heart) Old Coding Dx transplant - 29.00 (post lung), 361.00 or 805.00 (Renal), 429.00 (liver), 430.00 (pancreas).766.00 (heart), 781.00 (lung), 851.00 (BMT)

Kidney transplant vs ESRD

• If the patient has a Past history, transplanted kidney, do not also code the Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15 that occurred in the native kidneys, which was the reason for the transplant because having had ESRD is implied in having had a kidney transplant.
  • Exception: If the transplanted kidney has completely failed (e.g. the patient is back on dialysis), then do also code: Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15, because now it applies to the transplanted kidney. Also code Kidney transplant, failure or rejection or unspecified complication.

Past transplant recipient

Past history, transplanted kidney

• Kidney transplant, failure or rejection or unspecified complication covers several situations related to a Past history, transplanted kidney:
  • Ongoing acute or chronic rejection
  • The transplant has failed
  • Other complications that relate to the transplanted kidney itself.
• If you use this code, you should not also code Past history, transplanted kidney, because that is implicit in this code.

Michelle's content

The Primary ICD 10 diagnoses for a patient admitted preoperatively for a kidney transplant is:

• Preparatory care (incl preop optimization)

This Code will be linked with:

• Organ transplant candidate (waiting for organ)

ICD10 Guideline Transplant

Special coding considerations

• Almost (if not all) patients will have a comorb diagnosis of Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15. Rarely, a patient will have a transplant prior to ever being dialyzed. These patients would still be considered Stage 5, unless their GFR is greater than 15, in which case, use the chronic kidney disease code that corresponds to their GFR.
• Most transplant patients are coming from home, so Previous Location will be "home", and Previous Service will be "not applicable".
• Once a patient is discharged home post transplant, you will no longer code Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15 on subsequent admissions, unless the transplanted kidney has failed.
• Post op, creatinine levels should start to decrease. If levels continue to rise, and meet the Kidney, acute renal failure NOS criteria, then you can code this, and link it with Kidney transplant, failure or rejection or unspecified complication.
• If patients have a history of parathyroidectomy, then you can code a comorb of Past history, removal of organ NOS
• Don't code: Immunodeficiency state, NOS, and Surgical follow-up care for these patients post-op, because these are assumed/routine for all transplant patients.

CCI coding

• Often, admitted patients will receive a peritoneal or hemodialysis treatment prior to surgery. In this case, code this as an acquired CCI. If the patient requires a hemodialysis treatment post transplant as well, this will not be captured in the CCI, as we only code the first dialysis treatment during the hospitalization.
• To code the actual transplant (usually will be as an acquired, unless they are coming to your ward post-op), use "Kidney (T)", combined with "Transplant". As part of the procedure, patients will also have a ureteral stent placed. This is routine, and does not need to be coded as a CCI. If a biopsy of the kidney is done during the procedure, code this as "kidney (D)", combined with "Biopsy (non-endoscopic)". If a biopsy is done, it will usually be indicated in the OR's print out summary.

CMV+ or EBV+ prophylactic treatments

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 recipient positive tests.