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	ICD-10 CM Wikipedia ICD-10 Wikipedia WHO ICD10 documentation ICD10data.com

This diagnosis is a part of ICD10 collection.

• SMW
  • 2019-01-01
  • 2999-12-31
  • N18.5

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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

• 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).

ESRD vs Acute Renal Failure

• Do NOT code both
  • Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15

AND

• Any of the acute renal failure diagnoses (Kidney, acute tubular necrosis (ATN), Kidney, acute renal failure NOS, Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronic, Kidney, acute renal failure, postprocedural)

• 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

• 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.
  • Medical noncompliance in admit codes.
  • 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.

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

Candidate Combined ICD10 codes

• Code the cause, if known.

Related CCI Codes

• HD (Hemodialysis) if done while on your unit.

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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ICD10 Categories: ANCA-associated Vasculitis (AAV), Abdominal trauma, Abortion, Acute intoxication, Addiction, Adrenal Insufficiency, Adverse effect, Alcohol related, Allergy, Anemia, Anesthetic related, Aneurysm, Antibiotic resistance, Antidepressant related, Aortic Aneurysm, Arrhythmia, Arterial thromboembolism, Asthma, Atherosclerosis, Awaiting/delayed transfer, Bacteria, Benign neoplasm, Breast disease, Burn, COVID, Cannabis related, Cardiac septum problem, Cardiovascular, Cerebral Hemorrhage/Stroke, Chemical burn, Chronic kidney disease, Cirrhosis, Cocaine related, Decubitus ulcer, Delirium, Dementia, Diabetes, Diagnosis implying death, Double duty pathogen, ENT, Encephalitis, Encephalopathy, Endocrine disorder, Endocrine neoplasm, Exposure, Eye, Female genital neoplasm, Fistula, Fracture, Fungus, GI ulcer, Gastroenteritis, Gastrointestinal, Gastrointestinal neoplasm, Hallucinogen related, Has one, Head trauma, Head trauma (old), Healthcare contact, Heart valve disease, Heme/immunology, Heme/immunology neoplasm, Hemophilia, Hemorrhage, Hepatitis, Hereditary/congenital, Hernia, Hypertension, Hypotension, Iatrogenic, Iatrogenic infection, Iatrogenic mechanism, Imaging, Infection requiring pathogen, Infection with implied pathogen, Infectious disease, Inflammatory Bowel Disease, Influenza, Inhalation, Intra-abdominal infection, Ischemia, Ischemic gut, Ischemic heart disease, Joint/ligament trauma, Leukemia, Liver disease, Liver failure, Lower limb trauma, Lower respiratory tract infection, Lymphoma, Male genital neoplasm, Mechanism, Meningitis, Metabolic/nutrition, Metastasis, Misc, Muscle problem, Muscles/tendon trauma, Musculoskeletal/soft tissue, Musculoskeletal/soft tissue neoplasm... further results