Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15
| 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.
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
- It requires age, sex, race (black vs. white) and creatinine:
- Unless you know otherwise, use "white" race as default
- Use the most recent, stable, PRE-HOSPITAL creatinine value available
- When no creatinine clearance is listed, but the patient is a known dialysis patient then code Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15
- For all other CKD patients, i.e. those in whom we cannot easily identify the Stage, we’ll use Chronic kidney/renal disease, NOS (stage unspecified).
- Usually, it'll be identified by being on chronic dialysis
- 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)
About "Acute on Chronic renal failure"
- Our definition for Stage 5 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 CAN get an acute renal injury (ARF) on top of what we allow to be called Stage 5.
- 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
- 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.
- HD (Hemodialysis) from CCI picklist, as acquired, if they were dialyzed in your unit.
- Medical noncompliance in admit codes.
- Any other diagnosis that resulted in the ICU admission, in admit codes. Ex. Hyperkalemia, CHF, etc.
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: |
Candidate Combined ICD10 codes
- Code the cause, if known.
Related CCI Codes
Data Integrity Checks (automatic list)
| App | Status | |
|---|---|---|
| Can't check ICD10 ARF vs APACHE ARF | CCMDB.accdb | declined |
| Query check ICD10 only 1 stage of renal failure | CCMDB.accdb | implemented |
| Query check_ICD10_ESRD_vs_kidney_transplant | CCMDB.accdb | implemented |
| Query check_ICD10_ESRD_and_AKI_only_if_transplant | CCMDB.accdb | implemented |
| Query check ICD10 ESRD vs ARF | CCMDB.accdb | not feasible |
| Query check ApARF CRF | CCMDB.accdb | retired |
| Check CRF vs ARF across multiple encounters | Centralized data front end.accdb | declined |
| Query check ICD10 ESRD vs AP ARF | not entered | retired |
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