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 | |
This diagnosis is a part of ICD10 collection.
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discussion about new rules that is too long to work in template, see page |
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discussion about new rules that is too long to work in template, see page |
- 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
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ESRD vs Acute Renal Failure
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- 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
| Renal failure codes: |
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.
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