Query check CCI ICD10 Dialysis no Dx

Data Integrity Checks
Summary:	If there is a TISS28 entry for Hemodialysis there should be a corresponding Dx.
Related:	Intermittent hemodialysis (TISS Item), Peritoneal dialysis (TISS Item), CRRT (TISS Item), 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
Firmness:	hard check
Timing:	complete
App:	Centralized data front end.accdb
Coding:	query NDC_Dxs_vs_TISS_Dialysis
Uses L Problem table:	No
Status:	needs review
Implementation Date:	2019/01/06
Backlogged:	true

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1 We are getting a lot of positives where a requiring dx does not have a TISS. Is our list of requiring dxs reasonable? ~ 118 patients like this. The cross check will be re designed to only check that any TISS has a qualifying DX, but not that every requiring DX has a TISS, since KDIGO criteria might mean pt doesn't need dialysis.

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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

If there is a TISS28 entry for Hemodialysis there should be a corresponding Dx.

Dialysis TISS Items

• Intermittent hemodialysis (TISS Item) (T32)
• CRRT (TISS Item) (T33)
• Peritoneal dialysis (TISS Item) (T34)

Dialysis requiring Dxs

• Kidney, acute renal failure NOS
• Kidney, acute renal failure, postprocedural
• Kidney, acute tubular necrosis (ATN)

Dialysis qualifying Dxs

all #Dialysis requiring Dxs plus: Concept:Chronic Kidney Disease:

• Chronic kidney disease (chronic renal insufficiency, uremia) Stage 1, GFR GT 90
• Chronic kidney disease (chronic renal insufficiency, uremia) Stage 2, GFR 60-89
• Chronic kidney disease (chronic renal insufficiency, uremia) Stage 3, GFR 30-59
• Chronic kidney disease (chronic renal insufficiency, uremia) Stage 4, GFR 15-29
• Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15
• Chronic kidney/renal disease, NOS (stage unspecified)
• Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronic

• Hyperkalemia
• Congestive heart failure with pulmonary edema
• Fluid overload
• Metabolic acidosis: Acidosis, NOS or Kidney, renal tubular acidosis (RTA, all types)
• Drug overdoses and poisonings -- the main ones are:
  • Aspirin & other salicylates -- Aspirin or other salicylate or NSAID, overdose/toxicity
  • Valproic acid, carbemazepine (Tegretol), phenytoin (Dilantin), barbiturates -- Antiseizure drug NOS, overdose/toxicity
  • Metformin -- Insulin or other antidiabetes drug, overdose/toxicity
  • Lithium -- Psychiatric drug NOS, adverse effect
  • Theophylline -- Drug or biological substance/agent NOS, overdose/toxicity
  • Alcohols -- Alcohol (ethanol), poisoning or Toxic alcohols, poisoning
  • Diltiazem -- Calcium channel blocker, overdose/toxicity
  • Occasionally a few others (rare)

Checks

Has #Dialysis requiring Dxs but no #Dialysis TISS Items

If meets following the entry is an error:

• ICU patient
• LOS>3
• at least one #Dialysis requiring Dxs
• doesn't have any #Dialysis TISS Items

Has #Dialysis TISS Items but no #Dialysis qualifying Dxs

If meets following the entry is an error:

• at least one of #Dialysis TISS Items
• doesn't have one #Dialysis qualifying Dxs

Reality check

AG REPLY -- This is challenging since not everyone with either ARF or CRF gets dialysis AND not everybody who gets dialysis has renal failure -- e.g. dialysis is also occasionally used for drug overdoses, volume overload, and a very few other things.

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