Query check CCI ICD10 Dialysis no Dx

Data Integrity Checks
Summary:	If there is a TISS28 entry for Hemodialysis there should be a corresponding Dx.
Related:	Intermittent hemodialysis (TISS Item), Peritoneal dialysis (TISS Item), CRRT (TISS Item), ARF (Diagnosis), Pt Monitored while on Dialysis
Firmness:	hard check
Timing:	complete
App:	Centralized data front end.accdb
Coding:	not entered
Uses L Problem table:	No
Status:	needs review
Implementation Date:	not entered
Backlogged:	true

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If there is a TISS28 entry for Hemodialysis there should be a corresponding Dx.

Dialysis TISS Items

• Intermittent hemodialysis (TISS Item) (T32)
• CRRT (TISS Item) (T33)
• Peritoneal dialysis (TISS Item) (T34)

Dialysis requiring Dxs

• ARF (Diagnosis)(350) ------------- Tina this is old and needs to be removed from here
• Pt Monitored while on Dialysis (398) -------------- Ditto

Concept:Acute renal failure:

• Kidney, acute renal failure NOS
• Kidney, acute renal failure, postprocedural
• Kidney, acute tubular necrosis (ATN)
• Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronic

Dialysis qualifying Dxs

all #Dialysis requiring Dxs plus:

• CRF - Chronic Renal Failure(351) (not mandatory because what if they die/discharge before dialysis?) ------------- Ditto

Concept:Chronic Kidney Disease:

• Chronic kidney disease (chronic renal insufficiency, uremia) Stage 1, GFR GT 90
• Chronic kidney disease (chronic renal insufficiency, uremia) Stage 2, GFR 60-89
• Chronic kidney disease (chronic renal insufficiency, uremia) Stage 3, GFR 30-59
• Chronic kidney disease (chronic renal insufficiency, uremia) Stage 4, GFR 15-29
• Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15
• Chronic kidney/renal disease, NOS (stage unspecified)
• Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronic

• Hyperkalemia
• Congestive heart failure with pulmonary edema
• Fluid overload
• Metabolic acidosis: Acidosis, NOS or Kidney, renal tubular acidosis (RTA, all types)
• Drug overdoses and poisonings -- the main ones are:
  • Aspirin & other salicylates -- Aspirin or other salicylate or NSAID, overdose/toxicity
  • Valproic acid, carbemazepine (Tegretol), phenytoin (Dilantin), barbiturates -- Antiseizure drug NOS, overdose/toxicity
  • Metformin -- Insulin or other antidiabetes drug, overdose/toxicity
  • Lithium -- Psychiatric drug NOS, adverse effect
  • Theophylline -- Drug or biological substance/agent NOS, overdose/toxicity
  • Alcohols -- Alcohol (ethanol), poisoning by non-pharmaceuticals or Toxic alcohols, poisoning by non-pharmaceuticals
  • Diltiazem -- Calcium channel blocker, overdose/toxicity
  • Occasionally a few others (rare)

waiting for new list of poisonings from Allan before implementing this.

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Checks

Has #Dialysis requiring Dxs but no #Dialysis TISS Items

If meets following the entry is an error:

• ICU patient
• LOS>3
• at least one #Dialysis requiring Dxs
• doesn't have any #Dialysis TISS Items

Has #Dialysis TISS Items but no #Dialysis qualifying Dxs

If meets following the entry is an error:

• ICU patient
• LOS>3
• at least one of #Dialysis TISS Items
• doesn't have one #Dialysis qualifying Dxs

Reality check

I could add restrictions to reduce false positives but maybe not trap odd cases. Can you think of a reasonable restriction? In Check CRF/ARF against TISS Dialysis we were saying "LOS > 3days; I could add some death concept to the restrictions if we can think of them. Actually, is there any reason the two checks would NOT use essentially the same combination of criteria for Tasks (med) vs TISS (icu)? It might even end up being the same check... if the dx + criteria are right, must have either task or TISS?Ttenbergen 15:54, 2017 April 27 (CDT) AG REPLY -- This is challenging since not everyone with either ARF or CRF gets dialysis AND not everybody who gets dialysis has renal failure -- e.g. dialysis is also occasionally used for drug overdoses, volume overload, and a very few other things.

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ICD10/CCI

• I don't know if any of this is actually implemented. At this point it should probably wait for CCI/ICD10.

See also Renal Coding Considerations for ICD10.

Short stay patients, incl community hospitals

CRF/ARF patients may not receive dialysis if they are only there for a short time. That led to false=positives for the check, especially in community hospitals, so the restriction of "LOS>3" was added.