Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5
|Dx:||Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5|
|Pre-ICD10 counterpart:||CRF - Chronic Renal Failure, Renal Insufficiency-moderate (Cr greater than 240)|
|Charlson/ALERT Scale:||Renal disease|
|APACHE Como Component:||Renal|
|APACHE Acute Component:||Renal/Metabolic NOS, Metabolic/Renal NOS|
|External ICD10 Documentation|
- This stage is defined by having chronic renal insufficiency/disease with: being on chronic dialysis (of any type) ---------OR---------- GFR<15 mL/min.
- It requires age, sex, race (black vs. white) and creatinine:
- Unless you know otherwise, use "white" race as default
- Use the most recent, stable, PRE-HOSPITAL creatinine value available
- When no creatinine clearance is listed, but the patient is a known dialysis patient then code Chronic kidney disease (end-stage kidney disease, ESRD), 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).
- Usually, it'll be identified by being on chronic dialysis
- For ESRD not yet on HD, code HD in CCI's (acquired) if done in your unit for the first time.
How do you code patients with ESRD,who are being worked up for HD, and they present with "acute on chronic RF"? I used Kidney, acute renal failure NOS in admits, Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5 in comorbs, and HD in acquired CCI's. However, I'm getting an error with the APACHE ARF if I put "yes", because of the chronic RF code in comorbs. How should these types of patients be coded, so we are all doing it consistently? --Jvelasco 10:18, 2019 February 7 (CST)
- For patients who missed their dialysis tx and are admitted to ICU for urgent HD, code the following way:
- Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5 in comorbs.
- HD (Hemodialysis) from CCI picklist, as acquired, if they were dialyzed in your unit.
- Medical noncompliance in admit codes.
- Any other diagnosis that resulted in the ICU admission, in admit codes. Ex. Hyperkalemia, CHF, etc.
ESRD vs Acute renal failure
- Do NOT code both
- Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5 AND
- Any of the acute renal failure diagnoses, even if the person with the Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5 is not yet on dialysis, as that code includes GFR<15 mL/min even if not on dialysis yet.
- But it IS possible to code both one of the Acute Renal Failure/AKI codes AND one of the "lesser" CRF codes:
Kidney transplant vs ESRD
- If the patient has a Past history, transplanted kidney, do not also code the Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5 that occurred in the native kidneys, which was the reason for the transplant because having had ESRD is implied in having had a kidney transplant.
- Exception: If the transplanted kidney has completely failed (e.g. the patient is back on dialysis), then do also code: Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5, because now it applies to the transplanted kidney. Also code Kidney transplant, failure or rejection or unspecified complication.
Alternate ICD10s to consider coding instead or in addition
|Renal failure codes:|
Candidate Combined ICD10 codes
- Code the cause, if known.
Related CCI Codes
Data Integrity Checks (SMW)
|Query check ICD10 ESRD vs AP ARF||CCMDB.mdb||needs review|
|Query check ICD10 ESRD vs kidney transplant||CCMDB.mdb||implemented|
|Query check ICD10 ESRD vs ARF||CCMDB.mdb||needs review|
|Query check ICD10 only 1 stage of renal failure||CCMDB.mdb||ready to implement|
|Query check ApARF CRF||CCMDB.mdb||retired|
|Check CRF vs ARF across multiple encounters||Centralized data front end.accdb||needs review|