Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15: Difference between revisions

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{{ICD10 transition status
{{ICD10 transition status
| OldDxArticle =CRF, Renal Insufficiency-moderate (Cr greater than 240)
| OldDxArticle =CRF; Renal Insufficiency-moderate (Cr greater than 240)
| CurrentStatus = reconciled  
| CurrentStatus = reconciled  
| InitialEditorAssigned = Michelle Lagadi
| InitialEditorAssigned = Michelle Lagadi
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== Additional Info ==
== Additional Info ==
See [[Renal Coding Considerations for ICD10#About Coding Chronic Kidney Disease (CKD)]]
See [[ICD10 Guideline for Renal Coding#About Coding Chronic Kidney Disease (CKD)]]


===Definition===
===Definition===
*This stage is defined by having chronic renal insufficiency/disease with: being on '''chronic dialysis''' (of any type) ''OR'' '''[[GFR]]<15 mL/min'''.
*This stage is defined by having chronic renal insufficiency/disease with:  
** being on '''chronic dialysis''' (of any type) (this is the most common case)
:: OR
:* '''[[GFR]]<15 mL/min'''
 
{{ICD10 Guideline GFR instructions}}
{{ICD10 Guideline GFR instructions}}


*Usually, it'll be identified by being on chronic dialysis
{{ICD10 Guideline ESRD vs Acute renal failure}}


*For ESRD on chronic HD, also code [[Renal dialysis care, including dialysis itself]] in comorbs.
=== Admission for missed dialysis ===
*For ESRD not yet on HD, code HD in CCI's (acquired) if done in your unit for the first time.
*For patients who missed their dialysis tx and are admitted to ICU for urgent HD, code the following way:
*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.
**[[Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15]] in comorbs.
**[[Renal dialysis care, including dialysis itself]] in comorbs.
**[[Hemodialysis (intermittent)]] from CCI picklist, as acquired, if they were dialyzed in your unit.
**[[Medical noncompliance]] in admit codes.
**[[Medical noncompliance]] in admit codes.
**Any other diagnosis that resulted in the ICU admission, in admit codes. Ex. Hyperkalemia, CHF, etc.
**Any other diagnosis that resulted in the ICU admission, in admit codes. Ex. Hyperkalemia, CHF, etc.
AND
*[[HD (Hemodialysis)]] from CCI picklist, as an acquired procedure if done while on your unit.


===Related to Kidney Transplant===
If the patient has a [[Past history, transplanted kidney]], whether it is currently functioning or [[Kidney transplant, failure or rejection or unspecified complication|or not]] (and even if the failed transplanted organ has been surgically removed), this code should not be used. The reason is that ESRD is implicit if a person has had a kidney transplant. In that situation, instead you have the choices of:
*[[Past history, transplanted kidney]] -- use this one if the transplant is working
*[[Kidney transplant, failure or rejection or unspecified complication]] -- use this one if there's active rejection, or the transplant has failed
===Related to Acute renal failure codes===
*This code should never be accompanied by any of the codes representing acute renal failure/insufficiency:
**[[Kidney, acute renal failure NOS]]
**[[Kidney, acute tubular necrosis (ATN)]]
**[[Prerenal uremia/state]]
{{DA|Could we not use the Acute Renal Failure code for a patient who is categorized as stage 5, but has not yet started dialysis in the community? We will occasionally admit "non-dialysis" stage 5 patients who are admitted with fluid overload and require emergent initiation of dialysis.}}
{{DA|Should this dx be used in the [[Concept:Acute renal failure]] or not? That concept is referenced repeatedly and we should be consistent about it. }}


{{ICD10 Guideline Kidney transplant vs ESRD}}
{{Kidney Transplant Coding Guidelines}}


== Alternate ICD10s to consider coding instead or in addition ==
== Alternate ICD10s to consider coding instead or in addition ==
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== Related CCI Codes ==
== Related CCI Codes ==
* [[HD (Hemodialysis)]] if done while on your unit.


== CCMDB Data Integrity Checks ==
{{Data Integrity Check List}}
* [[Query check_ICD10_no_ESRD_w_ARF]]
* [[Query check_ICD10_only_1_stage_of_renal_failure]]


== Related Articles ==
== Related Articles ==

Latest revision as of 12:46, 2022 July 14

ICD10 Diagnosis
Dx: Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15
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: 2019-0: Metabolic/Renal NOS, 2019-0: Renal/Metabolic NOS
Start Date:
Stop Date:
External ICD10 Documentation

This diagnosis is a part of ICD10 collection.

  • SMW
    • 2019-01-01
    • 2999-12-31
    • N18.5
  • Cargo


  • Categories
  • SMW
  • Cargo


  • Categories
  • SMW
  • Cargo


  • Categories
  • SMW
  • Cargo


  • Categories

Additional Info

See ICD10 Guideline for Renal Coding#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) (this is the most common case)
OR

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

ESRD vs Acute Renal Failure

AND
  • UNLESS the patient has had a renal transplant and the transplanted kidney was functioning (and thus can experience acute renal failure)

About "Acute on Chronic renal failure"

  • Our definition for CRF includes two things, as above. If you are on dialysis then it is technically not possible to also have acute renal failure. And while our threshold of creatinine clearance < 15 ml/min USUALLY gets people on dialysis, that's not always the case. In other words, there are some people who don't need to start dialysis until their clearance is <10 or even 8 ml/min. THOSE people who by our definition have Stage 5 CKD cannot have ARF but rather this is considered a progression of their underlying disease. Instead of coding ARF, code the reason for dialysis ie. Fluid overload, Hyperkalemia, severe or symptomatic etc combined with Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15
  • And of course, if you previously had Stage 5, were on dialysis, then got a successful renal transplant, then you CAN get acute renal failure in your graft.


Admission for missed dialysis

AND

  • HD (Hemodialysis) from CCI picklist, as an acquired procedure if done while on your unit.


Kidney Transplant Coding Guidelines

For general coding information in the context of kidney transplants see Kidney Transplant Coding Guidelines. This includes how to code patients before, during and after their transplant admission.

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

Data Integrity Checks (automatic list)

 AppStatus
Can't check ICD10 ARF vs APACHE ARFCCMDB.accdbdeclined
Query check ICD10 only 1 stage of renal failureCCMDB.accdbimplemented
Query check_ICD10_ESRD_vs_kidney_transplantCCMDB.accdbimplemented
Query check_ICD10_ESRD_and_AKI_only_if_transplantCCMDB.accdbimplemented
Query check ICD10 ESRD vs ARFCCMDB.accdbnot feasible
Query check ApARF CRFCCMDB.accdbretired
Check CRF vs ARF across multiple encountersCentralized data front end.accdbdeclined
Query check ICD10 ESRD vs AP ARFnot enteredretired

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