Kidney, acute renal failure NOS

ICD10 Diagnosis
Dx:	Kidney, acute renal failure NOS
ICD10 code:	N17.9
Pre-ICD10 counterpart:	ARF, ARI
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:
External ICD10 Documentation	ICD-10 CM Wikipedia ICD-10 Wikipedia WHO ICD10 documentation ICD10data.com

This diagnosis is a part of ICD10 collection.

• SMW
  • 2019-01-01
  • 2999-12-31
  • N17.9

• Cargo

• Categories

• SMW

• Cargo

• Categories

• SMW

• Cargo

• Categories

discussion about new rules that is too long to work in template, see page, see also ARF (APACHE)

• SMW

• Cargo

• Categories

discussion about new rules that is too long to work in template, see page, see also ARF (APACHE)

• SMW

• Cargo

• Categories

• 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? 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 {{SignificantChangeICD10CCI | one sentence for the change since all it needs to do is highlight this}}, 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 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

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.Mlagadi 14:01, 2018 October 16 (CDT) I'll leave this for Allan to confirm, but the definition on p.19 of 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.

• SMW

• Cargo

• Categories

ESRD vs Acute Renal Failure

• Do NOT code both
  • Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15

AND

• Any of the acute renal failure diagnoses (Kidney, acute tubular necrosis (ATN), Kidney, acute renal failure NOS, Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronic, Kidney, acute renal failure, postprocedural)

• 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, severe or symptomatic 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.

Alternate ICD10s to consider coding instead or in addition

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
Can't check ICD10 ARF vs APACHE ARF	CCMDB.accdb	declined
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

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

Skin	Trauma Abdominal trauma Burn Chemical burn Fracture Head trauma Head trauma (old) Joint/ligament trauma Lower limb trauma Muscles/tendon trauma Neck trauma Potential trauma Thoracic trauma Traumatic Amputation Traumatic fracture Upper limb trauma Vascular trauma	Renal/urinary Chronic kidney disease Nephritic syndrome Renal failure Renal/Urinary neoplasm Urinary tract infection	Infectious disease Antibiotic resistance Bacteria COVID Double duty pathogen Encephalitis Fungus Iatrogenic infection Infection requiring pathogen Infection with implied pathogen Influenza Intra-abdominal infection Lower respiratory tract infection Meningitis Non-specific pathogens Osteomyelitis Pathogens Pneumonia Potential infection Tuberculosis Upper respiratory tract infection Virus
ENT	Testing Imaging	Cardiovascular Aneurysm Aortic Aneurysm Arrhythmia Arterial thromboembolism Atherosclerosis Cardiac septum problem Cerebral Hemorrhage/Stroke Heart valve disease Hemorrhage Hypertension Hypotension Ischemia Ischemic gut Ischemic heart disease Myocardial Infarction Pulmonary embolism Pulmonary hypertension Vasculitis Venous thromboembolism	Hereditary/congenital
Eye	Mechanism Transportation mechanism	Neoplastic Benign neoplasm Endocrine neoplasm Female genital neoplasm Gastrointestinal neoplasm Heme/immunology neoplasm Leukemia Lymphoma Male genital neoplasm Metastasis Musculoskeletal/soft tissue neoplasm Neuro neoplasm Primary malignancy Renal/Urinary neoplasm Respiratory neoplasm Skin neoplasm	Heme/immunology Allergy Anemia Heme/immunology neoplasm Hemophilia Leukemia Thrombocytopenia
Misc Adverse effect Alcohol related Allergy Anesthetic related Antidepressant related Awaiting/delayed transfer COVID Cannabis related Cocaine related Decubitus ulcer Diagnosis implying death Exposure Fistula Hallucinogen related Has one Healthcare contact Hemorrhage Iatrogenic Metabolic/nutrition Non-traumatic fracture Observation Organ removal Ostomy Overdose Paralysis Past medical history Poisoning Psychoactive substance NOS related Radiation related Retired Code Rheumatic disease Sedative related Shock Solvent related Spine Stimulant related Transplant	Reproductive Abortion Breast disease Female genital neoplasm Male genital neoplasm Peripartum	Gastrointestinal Cirrhosis GI ulcer Gastroenteritis Gastrointestinal neoplasm Hepatitis Hernia Inflammatory Bowel Disease Intra-abdominal infection Ischemic gut Liver disease Liver failure Pancreas disease Pancreatitis Peptic ulcer	Musculoskeletal/soft tissue Hernia Joint/ligament trauma Muscle problem Muscles/tendon trauma Musculoskeletal/soft tissue neoplasm Osteomyelitis
Psych Addiction Antidepressant related Delirium Dementia Hallucinogen related Opioid related Psychoactive substance NOS related Sedative related Solvent related Stimulant related Withdrawal	Respiratory Asthma Influenza Inhalation Lower respiratory tract infection Pleural abnormalities Pneumoconiosis Pneumonia Pneumothorax Pulmonary embolism Respiratory neoplasm Sleep disorder Tracheostomy Upper respiratory tract infection	Poisoning Acute intoxication Addiction Opioid related Overdose Poisoning by non-pharmaceuticals Stimulant related Withdrawal
Neuro Cerebral Hemorrhage/Stroke Encephalitis Encephalopathy Meningitis Neuro neoplasm Paralysis	Symptom/Sign Pain	Endocrine disorder Adrenal Insufficiency Diabetes Endocrine neoplasm Metabolic/nutrition

Show all ICD10 Subcategories

ICD10 Categories: ANCA-associated Vasculitis (AAV), Abdominal trauma, Abortion, Acute intoxication, Addiction, Adrenal Insufficiency, Adverse effect, Alcohol related, Allergy, Anemia, Anesthetic related, Aneurysm, Antibiotic resistance, Antidepressant related, Aortic Aneurysm, Arrhythmia, Arterial thromboembolism, Asthma, Atherosclerosis, Awaiting/delayed transfer, Bacteria, Benign neoplasm, Breast disease, Burn, COVID, Cannabis related, Cardiac septum problem, Cardiovascular, Cerebral Hemorrhage/Stroke, Chemical burn, Chronic kidney disease, Cirrhosis, Cocaine related, Decubitus ulcer, Delirium, Dementia, Diabetes, Diagnosis implying death, Double duty pathogen, ENT, Encephalitis, Encephalopathy, Endocrine disorder, Endocrine neoplasm, Exposure, Eye, Female genital neoplasm, Fistula, Fracture, Fungus, GI ulcer, Gastroenteritis, Gastrointestinal, Gastrointestinal neoplasm, Hallucinogen related, Has one, Head trauma, Head trauma (old), Healthcare contact, Heart valve disease, Heme/immunology, Heme/immunology neoplasm, Hemophilia, Hemorrhage, Hepatitis, Hereditary/congenital, Hernia, Hypertension, Hypotension, Iatrogenic, Iatrogenic infection, Iatrogenic mechanism, Imaging, Infection requiring pathogen, Infection with implied pathogen, Infectious disease, Inflammatory Bowel Disease, Influenza, Inhalation, Intra-abdominal infection, Ischemia, Ischemic gut, Ischemic heart disease, Joint/ligament trauma, Leukemia, Liver disease, Liver failure, Lower limb trauma, Lower respiratory tract infection, Lymphoma, Male genital neoplasm, Mechanism, Meningitis, Metabolic/nutrition, Metastasis, Misc, Muscle problem, Muscles/tendon trauma, Musculoskeletal/soft tissue, Musculoskeletal/soft tissue neoplasm... further results