Kidney Transplant Coding Guidelines

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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

Patient receiving transplant during this admission

ICD10 coding

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

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 CCI. This allows you to code the ARF codes without getting an error.
  • Often, admitted patients will receive a peritoneal or hemodialysis treatment prior to surgery. In this case, code this as an acquired CCI. 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, unless they are coming to your ward post-op), use "Kidney (T)", combined with "Transplant". As part of the procedure, patients will also have a ureteral 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 "kidney (D)", combined with "Biopsy (non-endoscopic)". 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

Transplant failure

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

Kidney transplant vs ESRD

CMV+ or EBV+ donors or recipients

  • We are NOT coding anything having to do with the Cytomegalovirus (CMV) or EBV status of the donor.
  • Accordingly, do not code a transplant recipient as infected or colonized with such organisms, but of course DO code them as infected with them IF THEY BECOME INFECTED WITH THEM -- which is not indicated just by the recipient being prophylactically treated for them after the transplant.
  • As per Colonized with organism (not infected), we are not tracking colonization with either of these viruses.

Past transplant recipient

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