Kidney, acute renal failure NOS
| ICD10 Diagnosis | |
| Dx: | Kidney, acute renal failure NOS |
| ICD10 code: | N17.9 |
| Pre-ICD10 counterpart: | ARF, ARI |
| Charlson/ALERT Scale: | none |
| APACHE Como Component: | none |
| APACHE Acute Component: | 2019-0: Renal/Metabolic NOS, 2019-0: Metabolic/Renal NOS |
| Start Date: | |
| Stop Date: | |
| External ICD10 Documentation | |
This diagnosis is a part of ICD10 collection.
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Patients are frequently admitted with AKI as part of dx list to medicine wards. To confirm, with the move to ICD 10 are kidney failure codes available options for use on all medicine wards? Pamela Piche 13:30, 2018 October 25 (CDT)
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Additional Info
- Acute renal failure (of any cause) is an old term. 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.
- And yet another synonym is Acute Renal Insufficiency (ARI).
- For any/all causes of this entity, the KDIGO guidelines identify that this is present if any one or more of the following are true:
- Increase in serum creatinine by 26 micromoles/L or more within 48 hours
- Increase in serum creatinine to 1.5 times baseline or more within the last 7 days
- Urine output less than 0.5 mL/kg/hour for 6 hours
- This specific NOS code excludes: Kidney, acute renal failure, postprocedural
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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.
Alternate ICD10s to consider coding instead or in addition
| Renal failure codes: |
Candidate Combined ICD10 codes
- Also code the cause, if known.
Data Integrity Checks
There are a number of coding rules related to renal diagnoses, centralized info about them is in Renal Coding Considerations for ICD10.
Data Integrity Checks (automatic list)
| App | Status | |
|---|---|---|
| Can't check ICD10 ARF vs APACHE ARF | CCMDB.accdb | declined |
| Query check CCI ICD10 Dialysis no Dx | 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 |
| Check CRF vs ARF across multiple encounters | Centralized data front end.accdb | declined |
Related CCI Codes
Legacy Info
We understand that the definition in the ICD10 codes is different than the definition in ARF (Diagnosis) and ARI and CRF - Chronic Renal Failure was. We are OK with that and will use the new definitions for the new codes, and the old ones for the old codes. Hopefully we can limit the amount of time where we consider both.
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