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

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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 as [[Acquired Procedure]] in CCI if done in your unit  
+
*For ESRD not yet on HD, code [[HD (Hemodialysis)]] 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? }}
+
{{DA |  
* 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)
+
* Code HD 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 ===
 
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.
 
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.
** 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)
+
{{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)
 +
}}
  
 
=== Admission for missed dialysis ===
 
=== Admission for missed dialysis ===

Revision as of 07:37, 2020 January 16

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: Metabolic/Renal NOS, 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
Poindexter.jpg
  • Code HD 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 Lisa Kaita 12:18, 2020 January 6 (CST)
  • SMW


  • Cargo


  • Categories

"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.

Interro-01.gif
  • 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 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)
  • SMW


  • Cargo


  • Categories

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)

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.accdbimplemented
Query check ICD10 only 1 stage of renal failureCCMDB.accdbimplemented
Query check ICD10 ESRD vs ARFCCMDB.accdbneeds review
Query check ICD10 ESRD and AKI only if transplantCCMDB.accdbneeds review
Query check ICD10 ESRD vs AP ARFCCMDB.accdbneeds review
Query check ApARF CRFCCMDB.accdbretired
Check CRF vs ARF across multiple encountersCentralized data front end.accdbdeclined

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