Uremic encephalopathy indicates the need for an emergent dialysis session, but there is no specific indexing for uremic encephalopathy as there is for pericarditis and neuropathy, Kline says. Pericarditis and neuropathy have specific subterm entries for “uremic” in both ICD-9-CM and ICD-10-CM, with bracketed codes providing direction to use the CKD code first followed by a secondary code for the associated condition. Also, CKD may be coded as the principal diagnosis if the admission is for acute uremic symptoms or diagnoses such as pericarditis and neuropathy and encephalopathy. One situation for which it would be appropriate to assign CKD as the principal diagnosis is if it is an initial diagnosis of CKD and the cause is unknown, Kline says. “Most often, the reason for the acute admission is perhaps an associated condition of CKD or end-stage renal disease, such as CHF or the volume overload issue and not the kidney disease itself,” says Brandy Kline, RHIA, CCS, CCS-P, CCDS, AHIMA-approved ICD-10-CM/PCS trainer and coordinator of training and quality assurance for Enjoin. Uremia, which is a clinical syndrome that develops due to byproducts of metabolism, is more often associated with CKD than it is with a temporary AKI. Rather, they will typically be admitted for an acute or intermediary complication, such as volume overload, congestive heart failure (CHF), hyperkalemia, or uremia. “A lot of doctors may not know how the stages correlate, so to help facilitate their answer, give them the table, and then let them make their own calculation,” Huff says.īecause CKD is a chronic condition, it will typically not be used as the principal diagnosis for people who are admitted as inpatients. When querying physicians to ask them for the stage, coders should provide the criteria for the various stages and not simply give them the diagnosis and the list of stages. “This patient dropped down to a lower stage 27, but that was due to AKI, and it came back up once they reestablished their hydration to their baseline.” “It’s very important to remember, when you’re establishing the CKD level, you use the best GFR that’s available in the record because that’s their true baseline,” Huff says. For this example, the patient is Stage 3 CKD. After hydration, the serum creatinine decreased to 1.7 mg% with a GFR of 42 ml/min. The serum creatinine on admission was 2.4 mg% with an estimated GFR of 27 ml/min. “Even if it’s not a CC or an MCC, you still need to specify if the patient has CKD because that’s a comorbid condition that does affect morbidity and mortality statistics and risk adjustments,” Huff says.Īnd it’s important to understand the difference between acute and chronic: If the patient has AKI, that means the condition is reversible CKD means that it’s not reversible.Ī patient with CKD is admitted for dehydration. Note that once a patient is placed on dialysis, even if the documentation states CKD stage 4, coding professionals should automatically assign the code for ESRD, he says.
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