Renal Transplant

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This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:

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Category/Organ System:	Category: Renal (old)
Type:	Category: Surgical Problem (old)
Main Diagnosis:	Renal Transplant Surgery
Sub Diagnosis:
Diagnosis Code:	80500 - Renal Transplant Surgery 80501 - Removal of Transplant-Organ 80502 - Failed 80503 - Rejection 80504 - Cadaver Donor 80505 - Living Donor
Comorbid Diagnosis:	80500 - Renal Transplant Surgery
Charlson Comorbid coding (pre ICD10):	2
Program:	Critical Care and Medicine
Status:	Currently Collected

For problems with kidney transplants, see Renal Transplant Problems.

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

• Patient Type (Registry): Surgical
• Admit diagnosis:Pre-Optimization-893
• Acquired diagnosis can not be both:
  • Renal Transplant-living donor-805-04
  • Renal Transplant-Cadaver donor-805-05
• 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.
• 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.

• If a renal transplant fails you might be able to code one of the following:
  • ARI (364-00)
  • Acute Tubular Necrosis (352-00)
  • ARF (Diagnosis) (350 **)

Coding during the admission where transplant occurs

Renal Transplant Patient coding process

• Registry Patient Type: Surgical
• Admit Type for APACHE II: 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 – 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) Template:Discussion

• Is the complication for organ source mandatory? Should there be a check for it? Ttenbergen 16:56, 3 September 2009 (CDT)
  • as per Fran/Gail: "Yes and it gets coded under renal transplant surgery"
• Where does the transplant itself get coded then? These instructions omit it.Ttenbergen 16:57, 3 September 2009 (CDT)
• Just to confirm - is the transplant surgery truly elective at all times? Would there not be an "expiry" consideration for cadaver donors? Ttenbergen 16:59, 3 September 2009 (CDT)
  • as per Fran/Gail: "I'm not sure if they always are, in the case of cadaveric transplants, although the need to be done immediately, the recipient always can choose not to receive. But I have never seen anyone refuse.. HSC cadaveric transplants are done immediately because we are a single center with donors and recipients in same facility. In other centers where the organ is shipped from east to west coast ideally the surgery should be done within 24hrs, but procedure can be done later. But then the issue of cold ischemia to organ arises. This is according to Dr. Ho (nephrologist)"

Renal Donor Coding Process

see Nephrectomy

Coding during future admissions of Renal Transplant Recipients

Intact and working transplant

• do not code CRF if the patient's transplant is working

Transplant not working

• if transplant is not working and patient meets coding requirement, code CRF
• enter Renal Transplant in comorbids
• enter one of the following codes as admit or complication as appropriate, prioritizing is as usual:
  • Renal Transplant Surgery - Rejection (361-01)
  • Renal Transplant Surgery - Other (361-90) if not clearly related to rejection

Considerations for entering Tasks

Renal Transplant patients sometimes qualify for one of the Dialysis Tasks either prior to transplant of if an earlier transplant has failed; check that article and code the task if applicable.

discussion

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

CMV+ or EBV+ diagnoses

• 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.
• Diagnosis of this would be unlikely during the transplant hospital stay and you are not expected to follow the patient past discharge. 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)

Template:Data Integrity Checks

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

Related Articles

see Category:Renal Problem for other renal problems