Kidney, acute tubular necrosis (ATN): Difference between revisions

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{{ICD10 Guideline ESRD vs Acute renal failure}}
{{ICD10 Guideline ESRD vs Acute renal failure}}


*{{Discussion}} If a patient has ATN on admission and later requires CRRT for kidney failure, do we need to put an acquired code of [[Kidney, acute renal failure NOS]] or not?  The crrt goes into the CCI codes.  --[[User:LKolesar|LKolesar]] 12:11, 2018 December 5 (CST)
{{Discuss | who=all |question=
 
*If a patient has ATN on admission and later requires CRRT for kidney failure, do we need to put an acquired code of [[Kidney, acute renal failure NOS]] or not?  The crrt goes into the CCI codes.  --[[User:LKolesar|LKolesar]] 12:11, 2018 December 5 (CST)
** What is special about this dx that would have you not code it? Is it that you are wondering whether coding a CCI means you don't have to code a dx? They are different things, you would still need to code the dx. Am I misunderstanding the question? Ttenbergen 07:09, 2018 December 14 (CST)
}}
== Alternate ICD10s to consider coding instead or in addition ==
== Alternate ICD10s to consider coding instead or in addition ==
{{ListICD10Category | categoryName = Renal failure}}
{{ListICD10Category | categoryName = Renal failure}}

Revision as of 08:09, 2018 December 14

ICD10 Diagnosis
Dx: Kidney, acute tubular necrosis (ATN)
ICD10 code: N17.0
Pre-ICD10 counterpart: Acute Tubular Necrosis (ATN)
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.

  • SMW
    • 2019-01-01
    • 2999-12-31
    • N17.0
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  • Categories
  • SMW
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  • Categories
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  • Categories

Additional Info

  • Acute tubular necrosis (ATN) is a medical condition involving the death of tubular epithelial cells that form the renal tubules of the kidneys.
  • It is one of many possible causes of acute kidney injury (AKI) -- also known as Acute Renal Failure. In the ICU it's among the most common causes of AKI.
  • Common causes of ATN include shock, and nephrotoxic drugs.
  • ATN is a diagnosis usually made clinically by: presence of AKI + presence of a known cause of ATN + urine electrolytes showing consistent findings (e.g. fractional excretion of sodium of >1%) + urine sediment showing lots of renal tubular epithelial cells.
  • If you use this code, there is no absolute requirement to also code one of the AKI/ARF codes, though you can if you want to.

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.


  • If a patient has ATN on admission and later requires CRRT for kidney failure, do we need to put an acquired code of Kidney, acute renal failure NOS or not? The crrt goes into the CCI codes. --LKolesar 12:11, 2018 December 5 (CST)
    • What is special about this dx that would have you not code it? Is it that you are wondering whether coding a CCI means you don't have to code a dx? They are different things, you would still need to code the dx. Am I misunderstanding the question? Ttenbergen 07:09, 2018 December 14 (CST)
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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)

 AppStatus
Can't check ICD10 ARF vs APACHE ARFCCMDB.accdbdeclined
Query check CCI ICD10 Dialysis no DxCCMDB.accdbimplemented
Query check_ICD10_ESRD_and_AKI_only_if_transplantCCMDB.accdbimplemented
Query check ICD10 ESRD vs ARFCCMDB.accdbnot feasible
Check CRF vs ARF across multiple encountersCentralized data front end.accdbdeclined

Related CCI Codes

Data Integrity Checks (automatic list)

 AppStatus
Can't check ICD10 ARF vs APACHE ARFCCMDB.accdbdeclined
Query check CCI ICD10 Dialysis no DxCCMDB.accdbimplemented
Query check_ICD10_ESRD_and_AKI_only_if_transplantCCMDB.accdbimplemented
Query check ICD10 ESRD vs ARFCCMDB.accdbnot feasible
Check CRF vs ARF across multiple encountersCentralized data front end.accdbdeclined

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