Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5

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ICD10 Diagnosis
Dx: Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5
ICD10 code: N18.5
Pre-ICD10 counterpart: Renal Insufficiency-moderate (Cr greater than 240), CRF - Chronic Renal Failure
Charlson/ALERT Scale: Renal disease
APACHE Como Component: Renal
APACHE Acute Component: Renal/Metabolic NOS, Metabolic/Renal NOS
External ICD10 Documentation
This diagnosis is a part of ICD10 collection.

Additional Info

See Renal Coding Considerations for ICD10#About Coding Chronic Kidney Disease (CKD)

Definition

  • This stage is defined by having chronic renal insufficiency/disease with: being on chronic dialysis (of any type) ---------OR---------- GFR<15 mL/min.

To calculate the GFR, use this easy website calculator: https://www.mdcalc.com/mdrd-gfr-equation

  • 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.


Swiss Army Knife.svg 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)
  • AG REPLY -- if you have Stage 5 CRF, even if not yet on dialysis, you CANNOT get any sort of acute renal failure unless you have had a renal transplant. Thus you situation is not really acute on chronic renal failure. If the Stage 5 was existing before admission, i.e. based on a prior creat clearance<15 mL/min, then it should be a comorb even if not prev dialyed. The acute admission then is going to be for either: (i) something such as hyperkalemia or fluid overload or uremia etc, i.e. a complication of the ESRD OR if they REALLY are being admitted for the Stage 5 (e.g. to install an A-V fistula in their arm and a Vascath), then the Stage 5 CRF should ALSO be an admit dx.


ESRD vs Acute renal failure

 Has ICD10Code
Kidney, acute tubular necrosis (ATN)N17.0
Kidney, acute renal failure NOSN17.9
Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronicN19
Kidney, acute renal failure, postproceduralN99.0

Kidney transplant vs ESRD

Alternate ICD10s to consider coding instead or in addition

Renal failure codes:
Chronic kidney disease codes:

Candidate Combined ICD10 codes

  • Code the cause, if known.

Related CCI Codes

Cross checks

Data Integrity Checks (SMW)

 AppStatus
Query check ICD10 ESRD vs kidney transplantCCMDB.mdbimplemented
Query check ICD10 ESRD vs AP ARFCCMDB.mdbneeds review
Query check ICD10 ESRD vs ARFCCMDB.mdbneeds review
Query check ICD10 only 1 stage of renal failureCCMDB.mdbready to implement
Query check ApARF CRFCCMDB.mdbretired
Check CRF vs ARF across multiple encountersCentralized data front end.accdbneeds review

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