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

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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 not yet on HD, code HD in CCI's (acquired) if done in your unit '''for the first time'''.
{{Discuss |
* Wouldn't you code HD as CCI even if they were on dialysis before? As in, wouldn't you just code it, no special instructions?
}}
 
=== "acute on chronic" is not a thing ===
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 [[Comorbid Diagnosis]] even if not prev dialyed.  The acute [[Admit Diagnosis]] then is going to be either: (i) something such as [[Hyperkalemia, severe or symptomatic]] or [[Fluid overload]] or any of the uremia codes 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.


=== Admission for missed dialysis ===
=== Admission for missed dialysis ===
*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 renal/kidney disease, ESRD), Stage 5, GFR LT 15]] in comorbs.
**[[Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15]] in comorbs.
**[[HD (Hemodialysis)]] 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.


{{ICD10 Guideline ESRD vs Acute renal failure}}


{{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 ==
Line 48: Line 43:


== Related CCI Codes ==
== Related CCI Codes ==
* [[HD (Hemodialysis)]] if done while on your unit.


{{Data Integrity Check List}}
{{Data Integrity Check List}}

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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