ICD10 Guideline for Renal Coding

This page contains an ICD10 Coding Guideline for ICD10 collection. See ICD10 coding guidelines for similar pages.

See also Renal Coding Considerations (old) for coding in the old system.

General Considerations

• Renal-related issues in ICD10 may include any of these things:

About Coding Chronic Kidney Disease (CKD)

• The following ICD10 codes can apply to CKD

• When there is a Creatinine clearance / GFR listed, it will be used to specify between Stages 1, 2, 3, 4, 5

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).

AKI

ICD10 does not have specific diagnosis of AKI (acute kidney injury), instead the codes that cover this are any of (as per Concept:Acute renal failure):

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

Candidate Combined ICD10 codes for renal codes

• Other codes you might want to use include:
  • Prerenal uremia/state
  • Hepatorenal syndrome
  • Kidney, nephropathy, drug or toxin induced
  • Nephritic syndrome, acute
  • Kidney, tubulo-interstitial nephritis/disease

Renal related guideline templates

Template:ICD10 Guideline Kidney transplant vs ESRD

Kidney transplant vs ESRD If the patient has a Past history, transplanted kidney, do not also code the Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15 that occurred in the native kidneys, which was the reason for the transplant because having had ESRD is implied in having had a kidney transplant. Exception: If the transplanted kidney has completely failed (e.g. the patient is back on dialysis), then do also code: Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15, because now it applies to the transplanted kidney. Also code Kidney transplant, failure or rejection or unspecified complication.

Template:ICD10 Guideline GFR instructions

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).

Template:ICD10 Guideline KDIGO Guidelines for Acute Renal Failure

Terminology related to Acute Kidney Injury Nephrologists want us to use the term Acute Kidney Injury (AKI). The reason is that this entity, whatever it's called, includes the full range of levels of kidney injury from minor all the way up to complete renal shutdown needing dialysis. Some other terms for it are: Acute Renal Failure Acute Renal Insufficiency (ARI) KDIGO Guidelines for Acute Kidney Injury (AKI) We use the KDIGO criteria for defining Acute Kidney Injury (AKI, Acute Renal Failure and Acute Renal Insufficiency) (starting January 1, 2019) The main thing here is identifying that the observed problem with kidney function is acute, rather than chronic - and THIS is the reason that identifying AKI requires trying to find a past/baseline value of serum creatinine The KDIGO guidelines delineate several different "levels/degrees" of AKI. You'll note that (at its lowest level) AKI is present even with pretty small rises in serum creatinine. While one MIGHT think that such small rises are inconsequential, indeed they are not. As indicated in the paper "Small Acute Increases in Serum Creatinine Are Associated with Decreased Long-Term Survival in the Critically Ill", even rises in creatinine of 27 mcg/L in ICU patients are associated with higher rates of death. Thus in this new schema we are not overcounting those with significant AKI, but before we probably were undercounting them. After a patient first developed AKI (as indicated by a rise in creatinine) it may continue to rise at a highly variable rate. The importance of this is that we should NOT re-code an AKI-related code each time the creatinine rises by 27 mcg/L if the continuing rise is simply part of the original event. It is possible, however, for a patient to have multiple AKI events. While this would be indicated by creatinine rising again after it stabilized or fell (without dialysis), it requires a medical judgement to determine whether the re-rising is really part of the initial episode or represents a new AKI episode. There is no firm rule about how long creatinine should cease rising to say the first AKI episode is completed. These criteria will apply everywhere we need to identify ARF/AKI -- including: Kidney, acute renal failure NOS ARF (APACHE) Kidney, acute tubular necrosis (ATN) Kidney, acute renal failure, postprocedural But NOT for Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronic - since as stated this code is for kidney failure or insufficiency when you don't know whether it's acute or chronic. In order to reduce the workload for identifying ARF/AKI, we will implement a first stage screening process to try and filter out the majority of people, who will NOT have AKI/ARF. We expect that this screening will misclassify a few people who do have AKI as not having it, but we also expect that most of those who are missed will continue to experience declining renal function and their AKI/ARF will be identified in the following days. First stage - screening Assume at admission that the patient does NOT have AKI/ARF if ALL of the following are true: (1) Creatinine <110 for males and <90 for females AND (2) No mention in chart of acute kidney/renal problems AND (3) No mention in the chart of oliguria The source used for these threshold values of serum creatinine are population-based surveys of serum creatinine in people without known kidney problems: Serum creatinine levels in the US population: third National Health and Nutrition Examination Survey (PubMed) The effect of age on serum creatinine levels in an aging population: relevance to vascular surgery. (PubMed) If ANY of 1, 2 or 3 are false, then go on to the full evaluation in the Second Stage Second stage - Full assessment Acute Kidney Injury (AKI) is present if ANY ONE OR MORE of the following are true (these are the KDIGO guidelines): (a) Urine output < 0.5 mL/kg/hour for 6 hours so, obviously, you can't make this determination until there has been at least 6 hours of observation of urine output also you need a weight -- if there isn't one already measured you have the following options: Wait for one to be done; Ask the nurse to do one; Do your best to estimate the weight, remembering that if the person appears to be of average size, then you could use default values based on average values in the Canadian population, i.e. 85 kg for men and 70 kg for women (b) Increase in serum creatinine by 27 micromoles/L or more within 48 hours so, while this may happen quickly and thus this criterion be met before 48 hrs, you cannot make a full determination that it is NOT true until you have at least 2 serum creatinine values separated by at least 48 hours in the case that the creatinine rises by >27, say in the first 12 hours, but then declines back down so that at the end of 48 hrs the net rise is <27, THEN THIS DOES QUALIFY AS AKI (c) Increase in serum creatinine to 1.5 times baseline or more within the last 7 days this criterion is important because since many people have some degree of CHRONIC renal insufficiency or failure, a solitary serum creatinine can't tell you if the high value is acute or chronic thus, to evaluate this criterion, seek a serum creatinine value at least 7 days old -- use whatever is the most recent value more than 7 days old that is available, even if it's years old if there ARE NO values >7 days old, then you can use the sex-specific normal value as follows: Men: 100 micromoles/L Women: 85 micromoles/L

Template:ICD10 Guideline Nephritic Syndrome

In ICD10 there are no codes specific for glomerulonephritis (GN) -- instead the various forms of that entity are included in the various codes for "Nephritic sydrome" Nephritic syndrome represents a class/category of renal diseases that are due to non-infectious inflammation of the glomerulus Though non-infectious, a classic cause of GN is immune-mediated and elicited by PRIOR infection by a variety of organisms, though Streptococci is the classic (so-called Post-strep GN) Although often primary, i.e. the etiology is auto-immune, there are numerous other conditions that can cause GNs (e.g. post-infectious which is an immune-mediated problem and not due to the organism itself; in association with other immune disorders such as Lupus and vasculitis; immune consequences of drug use such as iv heroin, others). When the etiology is NOT primary, combine the cause with the appropriate Nephritic syndrome code. Regarding the various codes for nephritic syndrome (Nephritic syndrome, acute, Nephritic syndrome, rapidly progressive, Nephritic syndrome, chronic, Nephritic syndrome, NOS) They include glomerulonephritis nephritis other inflammatory glomerular diseases Don't get confused, another way to classify glomerular diseases is by what they look like under the microscope (e.g. minimal change, membranous, crecentic, etc) -- but in ICD10 these are all included within all the codes for nephritic syndrome. The difference between the various Nephritic syndrome codes is clinical onset and persistence: code Nephritic syndrome, rapidly progressive if and only if the primary or renal team label it as "rapidly progressive", as in "Rapidly progressive GN" if acute in presentation/onset, but they don't label it as "rapidly progressive", then use Nephritic syndrome, acute if stated by the teams to be chronic, then use Nephritic syndrome, chronic if nothing is said about it's onset or persistence, then use the wastebasket of Nephritic syndrome, NOS Important to distinguish the various Nephritic syndrome codes from Nephrotic syndrome a classic cause of GN (especially Nephritic syndrome, rapidly progressive is as an immune after-effect of Strep infection, so-called Post-strep GN). To code this we will add a new code B98, to be called Other specified infectious agents as the cause of diseases classified by other ICD10 code -- this new code, with the appropriate Streptoccus code, is then combined with the appropriate Nephritic syndrome code to get Post-strep GN

Template:Kidney Transplant Coding Guidelines

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.

Data Integrity Checks (automatic list)

	App	Status
Can't check ICD10 ARF vs APACHE ARF	CCMDB.accdb	declined
Query NDC Dialysis TISS CCI	CCMDB.accdb	declined
Query check ICD10 ESRD vs kidney transplant	CCMDB.accdb	implemented
Query check ICD10 ESRD vs ARF	CCMDB.accdb	not feasible
Query check ICD10 ESRD and AKI only if transplant	CCMDB.accdb	ready to implement
Check CRF vs ARF across multiple encounters	Centralized data front end.accdb	declined
Query check ICD10 ESRD vs AP ARF	not entered	retired

Related Articles

see Category:Renal Problem (old) for other renal problems