EmailAcute renal failure (ARF) with chronic kidney disease (CKD) supplementary code
Publication Date: March 2017
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.
Question: Is it reasonable to assume that CKD is being monitored by the fact that the eGFR levels are being monitored, and hence that ACS 0002 applies to the documentation of 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.
Question: Is it reasonable to assume that CKD is being monitored by the fact that the eGFR levels are being monitored, and hence that ACS 0002 applies to the documentation of 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).
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.
Question: Is it reasonable to assume that CKD is being monitored by the fact that the eGFR levels are being monitored, and hence that ACS 0002 applies to the documentation of 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.
Question: Is it reasonable to assume that CKD is being monitored by the fact that the eGFR levels are being monitored, and hence that ACS 0002 applies to the documentation of 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.
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.
