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.

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

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Additional Info

Excludes:

• Kidney, acute renal failure, postprocedural

This code includes the following conditions that don't have separate ICD10 codes:

• Acute Kidney Injury (AKI)
• Acute Renal Insufficiency (ARI)

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

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.

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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.

Template: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.

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.

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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