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

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m (→‎Definition: code it as CCI, never mind if first time)
 
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*Usually, it'll be identified by being on chronic dialysis
 
*Usually, it'll be identified by being on chronic dialysis
  
*For ESRD not yet on HD, code HD in CCI's (acquired) if done in your unit '''for the first time'''.
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*For ESRD not yet on HD, code HD in as [[Acquired Procedure]] in CCI if done in your unit  
{{Discuss |  
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{{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? }}
* 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 ===
 
=== "acute on chronic" is not a thing ===

Latest revision as of 18:01, 2019 September 12

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: Renal/Metabolic NOS
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

  • Usually, it'll be identified by being on chronic dialysis
Interro-01.gif
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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"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

 ICD10 code
Kidney, acute tubular necrosis (ATN)N17.0
Kidney, acute renal failure NOSN17.9
Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronicN19
Kidney, acute renal failure, postproceduralN99.0

Kidney Transplant Coding Guidelines

For general coding information in the context of kidney transplants see Kidney Transplant Coding Guidelines.

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 (SMW)

 AppStatus
Query check ICD10 ESRD vs kidney transplantCCMDB.mdbimplemented
Query check ICD10 only 1 stage of renal failureCCMDB.mdbimplemented
Query check ICD10 ESRD vs ARFCCMDB.mdbneeds review
Query check ICD10 ESRD and AKI only if transplantCCMDB.mdbneeds review
Query check ICD10 ESRD vs AP ARFCCMDB.mdbneeds review
Query check ApARF CRFCCMDB.mdbretired
Check CRF vs ARF across multiple encountersCentralized data front end.accdbdeclined

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