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 (Hemodialysis)]] in as [[Acquired Procedure]] in CCI if done while admitted to your unit (i.e. including either physically on your unit, or while admitted the patient is taken to dialysis to get it done)
 
=== "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 dialyzed.  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.
{{Discuss |
* If I understand this correctly we should be able to code Stage 5 CRF as an admit dx (as in the above example) but currently the program does not allow for this [[User:Lkaita|Lisa Kaita]] 12:27, 2020 January 6 (CST)
** What is the error you get when you try? Does it complain about duplicate codes or about some incompatibility with renal codes? Ttenbergen 07:37, 2020 January 16 (CST)
*** it says that the patient has more than one chronic kidney failure code for the same admission [[User:Lkaita|Lisa Kaita]] 12:51, 2020 January 16 (CST)
}}


=== 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}}


{{Kidney Transplant Coding Guidelines}}
{{Kidney Transplant Coding Guidelines}}
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== 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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