Check CRF vs ARF across multiple encounters

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Data Integrity Checks
Summary: If a patient had a comorbid of CRF in any previous admission then ARF can not be an admit or complication in subsequent admissions.
Related: CRF, ARF (Diagnosis), Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15, 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, Renal Coding Considerations for ICD10
Firmness: hard check
Timing: complete
App: Centralized data front end.accdb
Coding: not entered
Uses L Problem table: not entered
Status: declined
Implementation Date: not entered
Backlogged: true

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Discussed 09:48, 2019 August 22 (CDT). The cross check only makes sense for Stage 5 renal failure. Also, people can come off dialysis, so there might really be a new acute after having been on dialysis. To do this right would require enormous work. Decided not to implement.

If a patient had a diagnosis of Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15 in any admission then Concept:Acute renal failure can not be an Admit Diagnosis or an Acquired Diagnosis in subsequent admissions.

old rules?

I think this section is largely old rules that no longer apply with how we define Comorbid Diagnosis now, ie if something was clearly present before admission we can now code it, even if it had not been diagnosed. Are any of these still required, with that in mind? Ttenbergen 21:17, 2018 October 26 (CDT)}

  1. if a patient is diagnosed with ARF (350) which means newly dialyzed and not on chronic outpatient dialysis prior to this admission (no 351 in comorbid) AND if during this encounter to hospital system, he continues to receive dialysis as he is moved around between hospitals and icu or medicine programs then he is still considered to be in ARF.(Trish)
    • How would someone who didn't receive dialysis before continue to receive dialysis? Ttenbergen 14:53, 29 October 2008 (CDT)
    • Julie's directions had been: "If having more than 1 encounter (i.e.: continuous or same hospital admission), then ARF(350) and CRF (351) should not appear together in at least one of the encounters." That's different from what Trish says now. Are we all on the same page? Ttenbergen 14:53, 29 October 2008 (CDT)
    • The definition that this patient would remain an ARF patient once they leave our ward, possibly are admitted somewhere where we don't collect, then maybe goes to the ICU, etc. is problematic since I don't think we can automatically assess that as the same hospital stay. More importantly, from what I hear about the quality of records travelling along with a patient, this is not something a DC at location 2 would be able to find out in any other way than by talking to the corresponding DC at location 1. This is an error prone, time consuming process, and I think we should re-consider the definition. Ttenbergen 14:53, 29 October 2008 (CDT)
  2. patients don't flip between (350)ARF and CRF (351) in the same encounter. (Trish)
    • so if someone enters hospital as ARF and stays here for 365 days on various wards with some icu stays, they should still be considered ARF during the last 3 day stay on a ward before they are discharged? I realize we don't flip back and forth but how about one way?Ttenbergen 14:53, 29 October 2008 (CDT)
  3. If the patient is discharged into the community, and will continue to receive outpatient dialysis, then the next time he is re admitted to a hospital in the city, he will be coded as CRF (351) in comorbid and admit or complication DX of ARF (350)cannot be used.(Trish)
    • as is true for anyone, so we can remove this point... Ttenbergen 14:53, 29 October 2008 (CDT)


  • Using the ICD10 renal codes, we still need to know when the transition from acute to chronic occurs - so we can decide whether the multiple encounters consistency checking is still relevant. --JMojica 11:51, 2018 November 14 (CST)
    1. is the transition on the next hospital stay? Example in this hospital stay, patient is diagnosed with ARF and stayed continuously in both ICU and ward in same or different hospital. On the next hospital stay, he is now chronic renal patient.
    2. Or the transition is on the next ICU or ward stay? Ex. the first stay is ICU and diagnosed with ARF. then patient was transferred in a ward of same or diff hospital - is he now a chronic renal patient?
    • The data collection instructions are in the related pages, and additional info is in Renal Coding Considerations for ICD10, but they are a beast of a network of concepts. Those might tell you how we currently propose to collect the renal codes, but not necessarily what you or the users of the data would want. Usually these cross checks would be driven by what you need for data requests, so do our proposed instructions line up with how you want to use this? Or is this maybe too case-by-case of a concept to even make a cross check? Ttenbergen 18:59, 2019 January 6 (CST)
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