Acute renal failure (ARF) with chronic kidney disease (CKD) supplementary codePublication Date: March 2017 Show
ICD 10 AM Edition: Ninth edition Retired Date: 31/5/2021 Query Number: 3162 Please advise when to code active vs supplementary code in the following scenarios: Scenario A: A patient is admitted with a diagnosis of Acute Renal Failure. The patient
also has a documented history of Chronic Kidney Disease. The eGFR levels are monitored throughout the admission but there is no further mention of management of the CKD. Scenario B: A type II diabetic patient is admitted with a diagnosis of Acute Renal Failure. The patient also has a documented history of
Chronic Kidney Disease. The patient's eGFR levels are monitored throughout the admission and patient seen by nephrologist but there is no further mention of management of the CKD. Scenario C: patient has a kidney transplant, and they are admitted for "viral illness due to immunocompromised status", then the transplant status is coded. The question is - is the CKD coded as a N code or a U code? (given that the CKD was not treated during the admission). Response VICC advises that it cannot be assumed that the taking of eGFR levels is increased monitoring of CKD, however there are other ways that CKD meets criteria for coding in scenarios A and B. For scenarios A and B, where acute renal failure is the principal diagnosis and chronic kidney disease (CKD) is also documented, the CKD should be coded to N18.- Chronic kidney disease. As stated in ACS 0001 Principal diagnosis/Acute and chronic conditions, �if a condition is described as both acute (subacute) and chronic and separate subterms exist in the Alphabetic Index at the same indentation level, code both and sequence the acute (subacute) code first�. Assignment of supplementary code U87.1 Chronic kidney disease, stage 3-5 is not appropriate. If the acute renal failure is documented as an additional diagnosis with CKD documented as the underlying condition, follow ACS 0002 Additional Diagnoses/Problems and underlying conditions to assign a code for both conditions. However if the CKD is not documented as the underlying condition, or does not meet ACS 0002 in its own right and is documented as being stage 3 - 5, apply ACS 0003 Supplementary codes for chronic conditionsand assign supplementary code U87.1 Chronic kidney disease, stage 3-5. In regard to scenario C, if the underlying cause of the viral illness is the immunocompromised status, the immunocompromised status (D89.8) is assigned as an additional diagnosis as per ACS 0002 Additional diagnoses/Problems and underlying conditions. In this case the transplant status code is not assigned and therefore the appropriate code for the CKD is U87.1 Chronic kidney disease, stage 3-5. If however the immunocompromised status is stated as being due to the transplant status, then a code for the transplant status is assigned and in accordance with ACS 1438 Chronic kidney disease the transplant status code must be assigned together with N18.3 Chronic kidney disease, stage 3 or higher as indicated by an eGFR level. It would not be appropriate to assign supplementary code U87.1 Chronic kidney disease, stage 3-5 in this circumstance. As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis. Coding AKI/ARFThere are several different codes that can be used to report the diagnosis of acute kidney injury and/or acute renal failure. This is one example of why diagnoses should not be coded by the use of only the Alphabetic Index within ICD-10-CM. It is imperative that coders also use the tabular before final determination of the code is made. If the coder only looks in the Alphabetic Index under injury | kidney | acute, the index goes to N17.9 (acute renal kidney failure, unspecified). If the type or cause of the AKI/ARF is further specified then N17.9 would not be appropriate. However, if the coder begins the search with the term “failure” there will be several selections for further specificity under failure | renal | acute. When coding AKI/ARF, there are instructional notes within the ICD-10-CM Index for coders to follow as well as Exclude1 and Excludes2 notes. When a cause for the AKI/ARF has been identified the underlying condition/cause should be reported also. Traumatic kidney injuries are reported with codes from S37.0-.
Sequencing of AKI/ARFThere are many different scenarios that would dictate the sequencing of AKI/ARF. The definition of PDX should always be used when determining the PDX. Remember that just because the condition may be present on admission does not necessarily mean that it is appropriate as PDX. Chapter specific guideline must be followed as well as other coding guidance that your record may require. Some of the most common specific guidelines that come to mind are sepsis, OB/delivery records and transplant complications. Let’s look at an example of each of these:
Note: The old sequencing guidance from ICD-9-CM regarding AKI/ARF and dehydration has been clarified in 2019. The sequencing is based on the circumstances of admission and will be a case by case decision. There is no rule that states that the AKI/ARF must be sequenced first over dehydration. References The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly. What is acute kidney injury superimposed on Chronic kidney disease?Superimposed ARF was defined as having both a peak inpatient serum creatinine greater than the last outpatient serum creatinine by ≥50% and receipt of acute dialysis. Results: Overall, 26% of CKD patients who suffered superimposed ARF died during the index hospitalization.
What is the difference between acute kidney injury and Chronic kidney disease?Acute kidney injury (AKI) occurs when the kidneys suddenly fail due to an injury, medication, or illness. Chronic kidney disease (CKD) is the gradual loss of kidney function mainly caused by high blood pressure, diabetes, and an inflammatory condition known as glomerulonephritis.
What is the ICDICD-10 code N18. 3 for Chronic kidney disease, stage 3 (moderate) is a medical classification as listed by WHO under the range - Diseases of the genitourinary system .
What is the difference between ICDN18. 31- Chronic Kidney Disease- stage 3a. N18. 32- Chronic Kidney Disease- stage 3b.
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