Transplants

annnd2009@gmail.com

Happy Friday !

Transplants feel so unfair (probably to recipients as well )-

NO matter what they all pay the same, right? I always feel like I am doing something wrong, cause how can that be, easy or complications and long stays... all the same...?

Back to my actual question, in a patient that went home and comes back...rejection syndrome, codes to compilation of transplanted kidney and would take cc/mcc...

So as I am looking at a week old stay with no cc...I'm wondering can I query for Transplant kidney complication WITH AKI? It seems reasonable to me and encoder takes it...

Thoughts, other suggestions, or general good to know info about initial transplant or subsequent visit admissions..

Thank you,
Ann Donnelly,RN,BSN,CCDS

annnd2009@gmail.com

...oh and is there any potential (clinical indicators) for asking in a way that would support any higher acuity than regular AKI?? Like ATN??

Thanks,
Ann

(there is no way to edit an original post as far as I could tell? )

evanspx@sutterhealth.org

Acute Renal Failure 'in'a transplanted organ is assigned code and there is no need to query for that code assignment.

I am lacking time today, but check Official Guidelines for Complications IN a Transplanted Organ and also check the code 996.81 in Coding Clinic.


The PDX is 996.82

If pt has ARF, a second code = 584.9 = CC

If pt has ATN as more specific form of ARF = MCC.

If there is a biopsy of the organ, check for ATN.

Thanks, PE

Paul Evans, RHIA, CCS, CCS-P, CCDS
 
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell:  415.412.9421

annnd2009@gmail.com

Hi,
I am a little confused- I am looking at another transplant where I would not consider AKI since their creatinine is within normal, I think a routine blood test screen showed rejections. So they still have 996.81 as pdx...it does not automatically come up with AKI (nor in this case would it appear it should) BUT did I misunderstand your last reply, saying that it would not be needed?

In my first case the patient HAD elevated renal function labs but AKI was not written, not ATN when I asked the question. Subsequently they wrote before I queried so I kind of let my question drop but now I am wondering---my first wonder...

If a patient admits post transplant (different admission) with elevated creatinine AND aki (or ATN is not written) is the query itself, inquiring about either of those conditions- depending on the elevation and length of elevation, make sense?

Thanks!
Ann

annnd2009@gmail.com

Thanks for the charts!

I think it was a routine lab test that showed…mediated immunity markers— something like that. I checked the chart (closed now)for WHY they came in and it seemed to be routine follow up lab work from December with the plan for plasmapheresis.

I thought you were saying on the prior response (last week) that AKI would be inferred (and in that case it probably should have but wasn’t written)- that’s what I was trying to determine. IF IT WASN’T WRITTEN - AKI (and criteria met) should I query.

I think the answer is yes…YES???

evanspx@sutterhealth.org

Yes..I think? Our practice re: Acute Kidney Injury is to issue a query if the pt meets clinical criteria (KDIGO) for acute renal injury/failure, but the diagnosis is not stated.

If an organ is ‘failed’ you should use the code for the ‘failed organ’ from the 996.8x series and any additional codes to report the specific degree of insufficiency, failure, manifestation(s), so on.

See the Guidelines for more information or search for 996.8X in ‘Coding Clinic’ for details.

Hope this is of some value.

Paul

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421