This page addresses follow-up questions and additional information pertinent to our webinar
Flushing out Kidney Anatomy, Disease Processes, and ICD-10-CM Coding.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: If a patient with end-stage renal disease (ESRD) presents with fluid overload for emergent dialysis, what is the principal diagnosis? Is the fluid overload integral to the ESRD?
A: Assign a code for fluid overload (E87.70) as the principal diagnosis and ESRD (N18.6) as an additional diagnosis. Fluid overload is not integral to ESRD and since this was the condition that precipitated inpatient admission, it is sequenced first (Source: Coding Clinic for ICD-10-CM/PCS, 1st Quarter 2023, page 19).
Q: If a patient presents with stage 5 CKD (N18.5) and progresses to ESRD (N18.6), do you code both conditions or just the ESRD?
A: Assign only one code from category N18 for chronic kidney disease (CKD) to reflect the highest level of severity. This would be N18.6 for ESRD (Source: Coding Clinic for ICD-10-CM/PCS, 1st Quarter 2013, page 18).
Q: Renal insufficiency is a big CDI topic since it could be more specifically documented as renal failure. Should CDI be working with providers to eliminate the terminology “renal insufficiency” in their documentation and get the provider to state “renal failure” instead?
A: No, it is inappropriate to tell providers to replace “renal insufficiency” with “renal failure” when there is no clinical criteria to support a diagnosis of renal failure. According to CDI Strategies, Volume 11, Issue 23, from May 18, 2017, renal insufficiency is a valid diagnosis noting that the kidneys are not working appropriately, and the patient should be monitored. But it is inappropriate to recommend documenting renal failure instead when clinical criteria are not present.
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Q: If the patient is status post kidney transplant and is admitted with graft vs. host disease, do you code this as a renal transplant failure in addition to GVHD?
A: No, this is coded as a kidney transplant complication (T86.19) with the code for GVHD. Do not assume that the renal transplant failed.
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Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Director of Coding Quality & Education
Kristi is the Director of Coding Quality & Education with more than 25 years of industry experience; she is responsible for the development of web-based, instructor-led, and webinar training materials; conducting training in ICD-10-CM/PCS and CPT; and performing DRG and APC audits. Kristi has an extensive background in coding education and consulting and is a national speaker and published writer on topics related to ICD-10 and CPT coding and code-based reimbursement. She has designed and developed training programs for inpatient and outpatient hospital-based coding, with a focus on vascular interventional radiology, interventional cardiology, orthopedics, and obstetrics.
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