Kidney Transplant Coding Guidelines: Difference between revisions

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==== Should [[Past history, transplanted kidney]] be coded during transplant admission ====

~~See~~ [[Past history, transplanted kidney~~#How~~ to ~~use~~ this in ~~regard~~ to ~~patient moving through their hospital admission~~]]

*These notes are to resolve possible ambiguity for the situation where the patient received the transplant during the current hospitalization.

*What if the transplant was done during the current hospitalization, and they move from place to place within the hospital?

**If the person was admitted to the service directly after the transplant surgery, [[Past history, transplanted kidney]] isn't used. For example, patient came in for elective transplant, had it, and came directly to SICU. In that case the SICU database record would have [[Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15|ESRD]] as an admitting diagnosis, and the transplant would be indicated by a CCI procedure code for it. So the SICU database record would not list [[Past history, transplanted kidney]].

**Continuing that example, after SICU the person routinely went to the ward for further routine postop convalesence, then again [[Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15|ESRD]] is an admitting diagnosis, and the transplant would be indicated by a CCI procedure code for it. So again this ward database record would '''not''' list [[Past history, transplanted kidney]].

**But: if the person was in SICU post-transplant, then went to a surgery ward where they developed new problem such as [[Diabetic ketoacidosis (DKA)]], and was then transferred to your Medicine ward, it would be appropriate to code '''[[Past history, transplanted kidney]]'''.

***So in brief, if a person had the kidney transplant during the current hospitalization, you'd only code '''[[Past history, transplanted kidney]]''' in the current database record if the reason for being admitted to your unit (ward or ICU) was a different problem, i.e. not the kidney transplant.

=== After transplant ===

*Once a patient is discharged home post transplant, you should not code [[Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15]] on subsequent admissions, UNLESS the transplant subsequently fails completely.

*On subsequent admissions, code [[Past history, transplanted kidney]]

*Once a patient is discharged home post transplant, you should '''not''' code [[Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15]] on subsequent admissions, UNLESS the transplant subsequently fails completely.

*The transplant can subsequently suffer from any number of insults that may then produce acute kidney injury of any type (e.g. related to transplant rejection or related to the same reason as the person's native kidneys failed, or to a newly acquired cause of renal injury) and/or any level of chronic kidney disease.

*'''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.

@@ Line 18: / Line 18: @@
 ==== Should [[Past history, transplanted kidney]] be coded during transplant admission ====
-See [[Past history, transplanted kidney#How to use this in regard to patient moving through their hospital admission]]
+*These notes are to resolve possible ambiguity for the situation where the patient received the transplant during the current hospitalization.
+*What if the transplant was done during the current hospitalization, and they move from place to place within the hospital?
+**If the person was admitted to the service directly after the transplant surgery, [[Past history, transplanted kidney]] isn't used.  For example, patient came in for elective transplant, had it, and came directly to SICU.  In that case the SICU database record would have [[Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15|ESRD]] as an admitting diagnosis, and the transplant would be indicated by a CCI procedure code for it.  So the SICU database record would not list [[Past history, transplanted kidney]].
+**Continuing that example, after SICU the person routinely went to the ward for further routine postop convalesence, then again [[Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15|ESRD]] is an admitting diagnosis, and the transplant would be indicated by a CCI procedure code for it. So again this ward database record would '''not''' list [[Past history, transplanted kidney]].
+**But: if the person was in SICU post-transplant, then went to a surgery ward where they developed new problem such as [[Diabetic ketoacidosis (DKA)]], and was then transferred to your Medicine ward, it would be appropriate to code '''[[Past history, transplanted kidney]]'''.
+***So in brief, if a person had the kidney transplant during the current hospitalization, you'd only code '''[[Past history, transplanted kidney]]''' in the current database record if the reason for being admitted to your unit (ward or ICU) was a different problem, i.e. not the kidney transplant.
 === After transplant ===
-*Once a patient is discharged home post transplant, you should not code [[Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15]] on subsequent admissions, UNLESS the transplant subsequently fails completely.
+*On subsequent admissions, code [[Past history, transplanted kidney]]
+*Once a patient is discharged home post transplant, you should '''not''' code [[Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15]] on subsequent admissions, UNLESS the transplant subsequently fails completely.
 *The transplant can subsequently suffer from any number of insults that may then produce acute kidney injury of any type (e.g. related to transplant rejection or related to the same reason as the person's native kidneys failed, or to a newly acquired cause of renal injury) and/or any level of chronic kidney disease.
 *'''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.