Kidney Transplant Coding Guidelines

This page provides information on coding the recipients of kidney transplants. For donors, see Guideline for coding living donor organ donation/Guideline for coding organ donation after death.

Patient waiting for transplant

Whether or not transplant happens during this admission, code

• Organ transplant candidate (waiting for organ)
• Almost (if not all) patients will have a Comorbid Diagnosis of Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15. Rarely, a patient will have a transplant prior to ever being dialyzed. These patients would still be considered Stage 5, unless their GFR is greater than 15, in which case, use the chronic kidney disease code that corresponds to their GFR.
• Most transplant patients are coming from home, so Previous Location will be "home"

Patient receiving transplant during this admission

ICD10 coding

The Primary Admit Diagnosis for a patient admitted preoperatively for a kidney transplant is:

• Preparatory care (incl preop optimization)
• This Code will be linked with Organ transplant candidate (waiting for organ)

CCI coding

• Transplant is an exception to the normal CCI coding rules. If a patient arrives on your ward, as long as they had their transplant on this hospital admission (even if it was days or weeks ago), if they are still in hospital due to issues arising from the transplant, then you will code the transplant as an Admit Procedure . This allows you to code the ARF codes without getting an error.
• Often, admitted patients will receive a peritoneal dialysis (Peritoneal dialysis) or hemodialysis (Intermittent hemodialysis (TISS Item) treatment prior to surgery. In this case, code this as an Acquired Procedure. If the patient requires a hemodialysis treatment post transplant as well, this will not be captured in the CCI, as we only code the first dialysis treatment during the hospitalization.
• To code the actual transplant (usually will be as an Acquired Procedure, unless they are coming to your ward post-op), use (T) Kidney - Transplant. As part of the procedure, patients will also have a urethral stent placed. This is routine, and does not need to be coded as a CCI. If a Biopsy of the kidney is done during the procedure, code this as (D) Kidney, combined with Biopsy. If a biopsy is done, it will usually be indicated in the OR's print out summary.

Should Past history, transplanted kidney be coded during transplant admission

• These notes are to resolve possible ambiguity for the situation where the patient received the transplant during the current hospitalization.
• What if the transplant was done during the current hospitalization, and they move from place to place within the hospital?
  • If the person was admitted to the service directly after the transplant surgery, Past history, transplanted kidney isn't used. For example, patient came in for elective transplant, had it, and came directly to SICU. In that case the SICU database record would have ESRD as an admitting diagnosis, and the transplant would be indicated by a CCI procedure code for it. So the SICU database record would not list Past history, transplanted kidney.
  • Continuing that example, after SICU the person routinely went to the ward for further routine postop convalesence, then again ESRD is an admitting diagnosis, and the transplant would be indicated by a CCI procedure code for it. So again this ward database record would not list Past history, transplanted kidney.
  • But: if the person was in SICU post-transplant, then went to a surgery ward where they developed new problem such as Diabetic ketoacidosis (DKA), and was then transferred to your Medicine ward, it would be appropriate to code Past history, transplanted kidney.
    • So in brief, if a person had the kidney transplant during the current hospitalization, you'd only code Past history, transplanted kidney in the current database record if the reason for being admitted to your unit (ward or ICU) was a different problem, i.e. not the kidney transplant.

After transplant

• On subsequent admissions, code Past history, transplanted kidney
• Once a patient is discharged home post transplant, you should not code Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15 on subsequent admissions, UNLESS the transplant subsequently fails completely.
• The transplant can subsequently suffer from any number of insults that may then produce acute kidney injury of any type (e.g. related to transplant rejection or related to the same reason as the person's native kidneys failed, or to a newly acquired cause of renal injury) and/or any level of chronic kidney disease.
• Don't code: Immunodeficiency state, NOS, and Surgical follow-up care for these patients post-op, because these are assumed/routine for all transplant patients.

Transplant failure

• Kidney transplant, failure or rejection or unspecified complication covers several situations related to a Past history, transplanted kidney:
  • Ongoing acute or chronic rejection
  • The transplant has failed
  • Other complications that relate to the transplanted kidney itself.

See Template:ICD10 Guideline Transplant Failure for some collection rules that apply to all transplants.

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.

Past transplant recipient

• Past history, transplanted kidney