Kidney Transplant Coding Guidelines

The Primary ICD 10 diagnoses for a patient admitted preoperatively for a kidney transplant is:

• Preparatory care (incl preop optimization)

This Code will be linked with:

• Organ transplant candidate (waiting for organ)

Special coding considerations

• Almost (if not all) patients will have a comorb diagnosis of Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15. Rarely, a patient will have a transplant prior to ever being dialyzed. These patients would still be considered Stage 5, unless their GFR is greater than 15, in which case, use the chronic kidney disease code that corresponds to their GFR.
• Most transplant patients are coming from home, so Previous Location will be "home", and Previous Service will be "not applicable".
• Once a patient is discharged home post transplant, you will no longer code Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15 on subsequent admissions, unless the transplanted kidney has failed.
• Post op, creatinine levels should start to decrease. If levels continue to rise, and meet the Kidney, acute renal failure NOS criteria, then you can code this, and link it with Kidney transplant, failure or rejection or unspecified complication.
• If patients have a history of parathyroidectomy, then you can code a comorb of Past history, removal of organ NOS
• Don't code: Immunodeficiency state, NOS, and Surgical follow-up care for these patients post-op, because these are assumed/routine for all transplant patients.

CCI coding

• Often, admitted patients will receive a peritoneal or hemodialysis treatment prior to surgery. In this case, code this as an acquired CCI. If the patient requires a hemodialysis treatment post transplant as well, this will not be captured in the CCI, as we only code the first dialysis treatment during the hospitalization.
• To code the actual transplant (usually will be as an acquired, unless they are coming to your ward post-op), use "Kidney (T)", combined with "Transplant". As part of the procedure, patients will also have a ureteral stent placed. This is routine, and does not need to be coded as a CCI. If a biopsy of the kidney is done during the procedure, code this as "kidney (D)", combined with "Biopsy (non-endoscopic)". If a biopsy is done, it will usually be indicated in the OR's print out summary.

CMV+ or EBV+ prophylactic treatments When a donor is found to be CMV+ or EBV+, the recipient will often prophylactically be put on antiviral medication. This does not mean the recipient is, or should be coded as CMV+ or EBV+. Code only based on recipient positive tests.