cardiorenal syndrome

blefevre

Good day to all... I have a question that I would like to ask the group.
A patient is admitted to hospital with acute on chronic renal failure CKD 3 and has a history of cad and hypertension but no mention of CHF. The nephrologist is documenting acute renal failure AKI on CKD 3/ cardiorenal syndrome. What would be the DRG assigned to this patient? I appreciate any help.
Thank you
Barbara Lefevre RN BSN CCDS
Saint Mary's Hospital
Waterbury, Conn.

rmhosler1

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From the information given it could go to acute on chronic kidney
failure ICD 5849.
Or
ICD 40490 HTN heart and CKD stage 4 without chf






Mary A. Holser MSN, RN, CDS
Alumnus CCRN
McLaren Bay Region
1900 Columbus Ave.
Bay City, Michigan 48708
(989) 891-8072
mary.hosler@mclaren.org

prector

Cardiorenal syndrome without CHF is coded to hypertensive heart & CKD not specified as benign or malignant (404.90) & CKD stage 3 is585.3.
Your pdx is AKI (584.9)& your DRG is 684 unless you have a cc or MCC.

Paula Rector, RHIT, CCDS

Sent from Paula's iPhone

jolene.file

I would agree with Paul, the AKI (584.9) is the principal dx. if it is the acute condition beomg treated. The 404.90 +585.3 are secondary. If the pt. had ac CHF with the cardiorenal syndrome than the 404.XX could be principal. Again, that depends on the thrust of treatment.

Jolene File,RHIT,CCS,CPC-H,CCDS
Documentation Improvement Specialist-Coder
Hays Medical Center
jolene.file@haysmed.com

rmhosler1

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The question I have is why then when you have HTN w HTN CVD and renal
disease w chf, why is the 404.xx positioned first with the MCC of chf. I
think I hear you saying the AKI is first but wouldn't that be a cc? with
the 404.xx first?


Mary A. Holser MSN, RN, CDS
Alumnus CCRN
McLaren Bay Region
1900 Columbus Ave.
Bay City, Michigan 48708
(989) 891-8072
mary.hosler@mclaren.org

jolene.file

If I understand it correctly, the reason for the AKI as principal in the AKI on CRF and HCVD  w/o CHF is that the acute condition is the AKI and the focus/thrust of treatment.    The AKI is not included in the code description for HCVD with HCKD.  You can sequence the HCVD w CHF as principal  (404.1X or 404.3X) when the pt. has an ac exacerb. CHF because the CHF is included in the code descriptor.   Hope  that is helpful.  Maybe someone else can explain it better. 
Also, The I-9 code book under 404 ...directs you to use additional codes for specific type of heart failure (428.0-428.83).  There is no directive on AKI.  C.Clinic 4th Qrtr. 2002- Heart Failure directs you to do the same.
Jolene File,RHIT,CCS,CPC-H,CCDS
Documentation Improvement Specialist-Coder
Hays Medical Center
jolene.file@haysmed.com

sbaine

Melissa,

I use the information from UpToDate on CRS as a guideline for specific clinical indicators to include in a CRS query. Have attached the link below.The clues to seeking out CRS per the article "is a patient with
1. acute HF develops AKI
2. chronic cardiac dysfunction with progressive CKD
3. worsening kidney function i.e. glomerulonephritis/renal ischemia develops acute HF
4.dx related i.e. DM or Sepsis that develops CKD/HF

I see a variety in our acute care hospital but the most prevalent is number 1.

A potential query would be:
76 y/o pt w/hx Hypertensive Chronic Diastolic Heart Failure p/w increasing Cr from baseline, Hx CKD stage 2-3 now with AKI on CKD stage 4-5

Clinical Indicators: Cr 4 on admission-now 7,GFR increasing now 23-baseline 55, pitting pedal edema, increasing orthopnea,noncompliant with cardiac meds, not responding to resumed cardiac meds, Renal Consult- possible hemodialysis

Dr Please specify a suspected,possible, probable or known clinical diagnosis related to the clinical information above.

reference:
Michael S Kiernan, MD;James E Udelson, MD, FACC;Mark Sarnak, MD
Marvin Konstam, MD;(2014). Cariorenal Syndrome:Prognosis and Treatment. http://www.uptodate.com/contents/cardiorenal-syndrome-prognosis-and-treatment


Hope this helps,

Sara Baine, MSN-ed,CCDS
MedPartnersHIM CDI Consultant
sbaine-c@medpartnershim.com
sara_baine@chs.net

don.cdi.rn@gmail.com

I'd caution folks in regards to the scenario of CHF leading to ARF -- this is a situation where physicians might well use the phrase of cardiorenal syndrom. BUT that is not the intent of the code -- rather the code captures the condition of longish standing htn that causes changes in the heart (often evidenced by LVH, etc.) that leads to HF.
I suspect that will leave oneself open to 3rd party audit.

There's a great article in the July edition of the Journal -- strongly encourage folks to check it out.

Don

>>> "CDI Talk" 11/20/2014 4:18 PM >>>
Thanks so much Sara! This is very helpful.


Melissa L. Windau, BSN,RN
Clinical Documentation Manager
Lima Memorial Health System
1001 Bellefontaine Avenue
Lima, Ohio 45804
Office: (419)- 221-6195
Cell: (419)-236-4899
mwindau@limamemorial.org

gwojo

Cardiorenal disease is another term for hypertensive heart and renal disease. In icd 10 the encoder will take you to I130, N18?, and, I50??

annnd2009@gmail.com

I'm not sure in the exact way you asked or response but...

But if he wrote cardio renal that's all you need. Assuming they have a baseline ckd. If not you might be able to ask if there might be a mild baseline ckd. Even unspecified ckd. But MUST have CKD-
Also, I assuming the chf exacerbation is specified- not needed for code but to capture for MCC. Code is: I13

Ann