Template:ICD10 Guideline ESRD vs Acute renal failure

This template contains info that is relevant to all the acute renal failure diagnoses.

To use:

{{ICD10 Guideline ESRD vs Acute renal failure}}

Background/History

This has been discussed repeatedly over time. Here is an attempt at a Chronology, newest first

• 2022-07-13 Task #8: confirmed that we will not allow coding Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15 with ARF.
• 2022-06-23 - In emails Julie, Lisa and Tina decided to hold off on the change from the day before to review reasons why this was changed before.
• 2022-06-22 - At JALT meeting we discussed definition for query Check CRF vs ARF across multiple encounters; instructions were changed to no longer allow ARF to be collected at same time as CRF (I can't remember the reasons, can Julie or Lisa fill in?)
• 2020-01-23 - Task(10) we discussed this at task: Some mild Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15 cases can have AKI following Template:ICD10 Guideline KDIGO Guidelines for Acute Renal Failure, so we allowed entering them together (query check_ICD10_ESRD_vs_ARF disabled, deleted this template page ICD10 Guideline ESRD vs Acute renal failure
• 2022-01-10 Task:
  • Can ESRD be both and Admit and a Comorbid diagnosis? --> Answer is YES, if it was present prior to hospital admission AND it satisfies the criteria for an Admit diagnosis.
  • Can a patient have both acute renal failure and ESRD (Stage 5)? --> Answer is YES, with limitation:.
  • If the criteria for Stage 5 is being on dialysis, then the answer is No -- this is the limitation
  • But if the criteria is creatinine clearance <15 ml/min in someone NOT yet on dialysis, then YES.
• 2019-08-22 - Discussed in context of Check CRF vs ARF across multiple encounters and decided that, since people can come off dialysis, there might really be a new acute after having been on dialysis; messy so decided not to implement this
  • at some point we defined AKI by Template:ICD10 Guideline KDIGO Guidelines for Acute Renal Failure
  • at some point we defined Chronic kidney disease (chronic renal insufficiency, uremia) Stage 1, GFR GT 90 rather than defining
  • when we moved to ICD10 there was a desire to maintain that rule
• pre/ancient: In our old coding schema we defined CRF as being "on dialysis" and ARF as "newly dialyzed", so combining the two by definition did not make sense; there were some exceptions for patients who had a kidney transplant and came off dialysis; there was talk about some fairly complex cross checks between encounters - Julie may have had these in SAS but AFAIK they were never implemented in CFE. There was much discussion whether the re-set for chronic state should be this ward stay, this hospitalization, this hospitalization across the city.

see more details for dx schema

We used to not allow this in the old dx coding schema: if a patient is diagnosed with ARF (350) which means newly dialyzed and not on chronic outpatient dialysis prior to this admission (no 351 in comorbid) AND if during this encounter to hospital system, he continues to receive dialysis as he is moved around between hospitals and icu or medicine programs then he is still considered to be in ARF.(Trish) How would someone who didn't receive dialysis before continue to receive dialysis? Ttenbergen 14:53, 29 October 2008 (CDT) Julie's directions had been: "If having more than 1 encounter (i.e.: continuous or same hospital admission), then ARF(350) and CRF (351) should not appear together in at least one of the encounters." That's different from what Trish says now. Are we all on the same page? Ttenbergen 14:53, 29 October 2008 (CDT) The definition that this patient would remain an ARF patient once they leave our ward, possibly are admitted somewhere where we don't collect, then maybe goes to the ICU, etc. is problematic since I don't think we can automatically assess that as the same hospital stay. More importantly, from what I hear about the quality of records travelling along with a patient, this is not something a DC at location 2 would be able to find out in any other way than by talking to the corresponding DC at location 1. This is an error prone, time consuming process, and I think we should re-consider the definition. Ttenbergen 14:53, 29 October 2008 (CDT) patients don't flip between (350)ARF and CRF (351) in the same encounter. (Trish) so if someone enters hospital as ARF and stays here for 365 days on various wards with some icu stays, they should still be considered ARF during the last 3 day stay on a ward before they are discharged? I realize we don't flip back and forth but how about one way?Ttenbergen 14:53, 29 October 2008 (CDT) If the patient is discharged into the community, and will continue to receive outpatient dialysis, then the next time he is re admitted to a hospital in the city, he will be coded as CRF (351) in comorbid and admit or complication DX of ARF (350)cannot be used.(Trish)

Actual template content is below here:

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ESRD vs Acute Renal Failure

• Do NOT code both
  • Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15

AND

• Any of the acute renal failure diagnoses (Kidney, acute tubular necrosis (ATN), Kidney, acute renal failure NOS, Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronic, Kidney, acute renal failure, postprocedural)

• 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.