ICD10 Guideline for Renal Coding

This page contains an ICD10 Coding Guideline for ICD10 collection. See ICD10 coding guidelines for similar pages.

See also Renal Coding Considerations for coding in the old system.

This article needs cleaning up as regards suggestion for NEW/changed renal coding rules -- to be discussed by Julie, Trish, Tina, Allan.

ALSO, once that's done, need to correctly link THIS new renal coding article (instead of the old one) to the new acute and chronic renal failure articles.

General Considerations

• Renal-related issues in ICD10 may include any of these things:
  • Glomerular diseases -- including glomerulonephritis=nephritic syndrome
  • Renal tubulo-interstitial diseases -- including renal infections, obstruction, reflux, drugs/toxins
  • Renal failure -- including acute, all 5 stages of CKD
  • Urolithiasis
  • Other disorders of kidney and ureter -- including renal tubular acidosis (RTA), diabetes insipidus (DI), renal cysts, polycystic kidney disease
  • Other diseases of urinary system -- including bladder, urethra, UTI
  • Kidney transplant, failure or rejection or unspecified complication
  • Organ transplant candidate (waiting for organ)
  • Past history, transplanted kidney
  • Prerenal uremia/state

About Coding Chronic Kidney Disease (CKD)

• There are 7 ICD10 codes that may apply to CKD

• When there is a Creatinine clearance / GFR listed, it will be used to specify between Stages 1, 2, 3, 4, 5
• When no Creatinine clearance is listed, but the patient is a known dialysis patient, we will identify him/her as CKD, Stage 5
• For all other CKD patients, i.e. those in whom we cannot easily identify the Stage, we’ll use Chronic kidney disease, NOS (stage unspecified).

Miscellaneous Notes

• ICD10 does not have specific diagnosis of AKI (acute kidney injury), instead the codes that cover this are any of:
  • Kidney, acute renal failure NOS
  • Kidney, acute renal failure, postprocedural
• Other codes you might want to use include:
  • Prerenal uremia/state
  • Hepatorenal syndrome
  • Kidney, nephropathy, drug or toxin induced
  • Nephritic syndrome, acute
  • Kidney, tubulo-interstitial nephritis/disease
• Never code both ESRD (Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5) and any of the acute renal failure codes.
  • The only time you might be inclined to do so is in the presence of a failed kidney transplant, where the ESRD would refer to the failure of the native kidney, and the acute renal failure to the transplanted kidney, but don't do it even there, because the FACT of a kidney transplant automatically indicates that ESRD had occurred.

There are a few restrictions about which renal diagnoses can be coded together. These checks are currently done partly by Pagasa (!_Automated_Data_Integrity_Checks#CRF_vs_ARF) and have been partly implemented in CCMDB.mdb.

Acute or Chronic Renal problems in patient with Renal Transplant Failure

• If a kidney transplant has failed, then code Kidney transplant, failure or rejection or unspecified complication AND it's OK to also code acute or chronic renal condition, as appropriate.

Just a comment about CRF - Chronic Renal Failure: when pt has Renal Transplant Problems and/or Renal Transplant - Removal of Transplant-Organ and requires dialysis, they can have acquired diagnoses of ARF (Diagnosis), Acute Tubular Necrosis (ATN) and/or ARI, which is related to their new donor kidney.

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• A person can't have both ESRD and acute renal failure. So do not code BOTH of Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5 AND acute renal failure (Kidney, acute renal failure NOS) or ATN (Kidney, acute tubular necrosis (ATN))

These rules are currently checked at the main office and result in calls for clarification from Pagasa if broken. Some of them have been added to CCMDB.mdb, more are to follow.

Allan/Tina still need to check on these things:

Cross checks re. ESRD and acute failure

• SMW

• Cargo

• Categories

Proposed new checks/rules:

Change the rule to that you can’t ever have both any of the forms of acute renal failure and end-stage renal disease (in ICD10, the latter is: Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5)

Clearly this works OK for those without transplant. But it also works WITH a failed or failing transplant if we also make the rules that

• If a person has a functioning kidney transplant, do NOT code the ESRD they had before the transplant (i.e. Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5 goes without saying).

• Never code both [Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5]] and any of the acute renal failure codes.
  • The only time you might be inclined to do so is in the presence of a failed kidney transplant, where the ESRD would refer to the failure of the native kidney, and the acute renal failure to the transplanted kidney, but don't do it even there, because the FACT of a kidney transplant automatically indicates that ESRD had occurred

Apache vs. CRF comorbid

• see Check ApARF CRF.

Apache vs. ARF Dx

cross-checks impossible due to different definitions, see ARF (Diagnosis) and ARF (APACHE)

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• Check CRF/ARF against TISS Dialysis

Related Articles

see Category:Renal Problem (old) for other renal problems