We are using the criteria from KDIGO Clinical Practice Guideline for Acute Kidney Injury, part of which states -
2.1.1: AKI is defined as ANY of the following (Not Graded):
* Increase in SCr by X0.3 mg/dl (X26.5 lmol/l) within 48 hours; or
* Increase in SCr to X1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or
* Urine volume o0.5 ml/kg/h for 6 hours
I have not seen CMS publically endorse or verify any clinical definition(s), and I doubt CMS would vet this particular definition. I do not believe all 3rd parties accept this definition as 'valid', based upon denials I have reviewed. However, my opinion is that these 3rd parties either are not current in their understanding of all clinical definitions, either by neglect or choice.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Supervisor, Clinical Documentation Integrity, Quality Department
There was a great track related to this at the ACDIS conference this year. Go to ACDIS web site under forms and tools then to conference and the power point is there "THE KIDNEY DISEASE ACRONYM SPECTRUM: ARI, CKD, AKI, ARF, and ESRD." In this track Dr La Charite mentions that the ARF/AKI definition was revised in Aug 2011 by KDIGO. Any rise in serum Creatinine of 1.0 mg/dl or more above patient's baseline OR Any rise greater than or equal to 1.5 times patients baseline serum Creatinine (Baseline=lowest recorded Creatinine value for patient in preceding 3 months)
Hope this helps! [cid:image001.jpg@01CD5384.727AEEA0] Dawn M. Vitalone, RN Clinical Documentation Improvement Specialist Community Hospital Munster, IN 46321 dvitalone@comhs.org 219-513-2611
VOLUME 2 | ISSUE 1 | MARCH 2012 of KDIGO has different definitions for Acute Kidney Injury - coding to 584.9 - I was not able to attend the conference, but I have seen the definition offered during the convention and referenced by Dawn. Pg 8 of the KDIGO, published after August of 2012 offers different criteria for acute kidney injury - seems perplexing? Was any reconciliation for these definitions offered during the convention? The website is listed: http://www.kidney-international.org
Section 2: AKI Definition
2.1.1: AKI is defined as any of the following
Increase in SCr by X0.3 mg/dl (X26.5 lmol/l) within 48 hours; or
Increase in SCr toX1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or
Urine volume o0.5 ml/kg/h for 6 hours.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Supervisor, Clinical Documentation Integrity, Quality Department
Comments
Acute Kidney Injury, part of which states -
2.1.1: AKI is defined as ANY of the following (Not Graded):
* Increase in SCr by X0.3 mg/dl (X26.5 lmol/l) within 48 hours;
or
* Increase in SCr to X1.5 times baseline, which is known or
presumed to have occurred within the prior 7 days; or
* Urine volume o0.5 ml/kg/h for 6 hours
I have not seen CMS publically endorse or verify any clinical
definition(s), and I doubt CMS would vet this particular definition.
I do not believe all 3rd parties accept this definition as 'valid',
based upon denials I have reviewed. However, my opinion is that these
3rd parties either are not current in their understanding of all
clinical definitions, either by neglect or choice.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org
Any rise in serum Creatinine of 1.0 mg/dl or more above patient's baseline
OR
Any rise greater than or equal to 1.5 times patients baseline serum Creatinine (Baseline=lowest recorded Creatinine value for patient in preceding 3 months)
Hope this helps!
[cid:image001.jpg@01CD5384.727AEEA0]
Dawn M. Vitalone, RN
Clinical Documentation Improvement Specialist
Community Hospital
Munster, IN 46321
dvitalone@comhs.org
219-513-2611
Acute Kidney Injury - coding to 584.9 - I was not able to attend the
conference, but I have seen the definition offered during the convention
and referenced by Dawn. Pg 8 of the KDIGO, published after August of
2012 offers different criteria for acute kidney injury - seems
perplexing? Was any reconciliation for these definitions offered during
the convention? The website is listed:
http://www.kidney-international.org
Section 2: AKI Definition
2.1.1: AKI is defined as any of the following
Increase in SCr by X0.3 mg/dl (X26.5 lmol/l) within 48 hours; or
Increase in SCr toX1.5 times baseline, which is known or presumed to
have occurred within the prior 7 days; or
Urine volume o0.5 ml/kg/h for 6 hours.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org
2.1.1: AKI is defined as any of the following (Not Graded): Increase in SCr by X0.3 mg/dl (X26.5 lmol/l) within 48 hours;
or Increase in SCr to X1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or
Urine volume o0.5 ml/kg/h for 6 hours.
Paul Evans, RHIA, CCDS, CCS, CCS-P