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

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*For ESRD not yet on HD, code HD in as [[Acquired Procedure]] in CCI if done in your unit  
*For ESRD not yet on HD, code HD in as [[Acquired Procedure]] in CCI if done in your unit  
{{Discuss | only if ''done on'' your unit, or also if done while admitted to your unit? Do they ever haul people off to dialysis while admitted? }}
{{Discuss | only if ''done on'' your unit, or also if done while admitted to your unit? Do they ever haul people off to dialysis while admitted? }}
* on the medical wards patients go to the dialysis unit to be dialyzed, they are not dialyzed on the wards [[User:Lkaita|Lisa Kaita]] 12:18, 2020 January 6 (CST)


=== "acute on chronic" is not a thing ===
=== "acute on chronic" is not a thing ===

Revision as of 13:18, 2020 January 6

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
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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
only if done on your unit, or also if done while admitted to your unit? Do they ever haul people off to dialysis while admitted? 
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  • on the medical wards patients go to the dialysis unit to be dialyzed, they are not dialyzed on the wards Lisa Kaita 12:18, 2020 January 6 (CST)

"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

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.


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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