Query or not?

arozhkovskaya

When doc documents Acute on chronic CKD, do you just code it to 584.9 or query the doc whether it meant ARF (AKI)?
We always used to query, but I hear from coding professional that they would code it to 584.9.
Thanks,

Anna Rozhkovskaya, RHIT, CCS, CCS-P
Manager, Clinical Documentation Improvement
Memorial Healthcare System
Health Information Management Department
2990 Executive Way, Miramar, Fl 33025
(954)276-9957 Office
(954)265-6974 Mobile
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evanspx@sutterhealth.org

I'd always query the term 'acute kidney disease' as this does not code to 584.9.

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

evanspx@sutterhealth.org

canderson

Here, the coders will take to 5849 without Query clarification.

evanspx@sutterhealth.org

I believe that is an error - check the Index and there is not a pathway to 584.9 for the term 'acute kidney disease'. We query this term.


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

evanspx@sutterhealth.org

arozhkovskaya

Yes, this is what I was referring to, but coders stating that since CKD codes to chronic renal failure, the acute on chronic codes to 584.9. I disagree with this.

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, September 14, 2015 1:47 PM
To: Rozhkovskaya, Anna
Subject: RE:[cdi_talk] Query or not?

I believe that is an error - check the Index and there is not a pathway to 584.9 for the term 'acute kidney disease'. We query this term.


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

evanspx@sutterhealth.org

evanspx@sutterhealth.org

Given 584.9 (acute kidney injury/failure) is a VERY common (and possibly 'sole') CC and a factor for ROM assignment, I'd review the coding guidelines and index for this topic. I can only state that my staff will query the term 'acute kidney disease', and it is pertinent the Official Index codes directly to the code referenced earlier, which is not 584.9.

Best...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

evanspx@sutterhealth.org

arozhkovskaya

Thanks so much, everyone. I completely agree with querying!

evanspx@sutterhealth.org

Please clarify the nature of the patient's renal status:

Physician Response:*


Acute Kidney Injury / Failure
Tubular Necrosis
Acute Cortical Necrosis
Medullary Necrosis
Other Diagnosis

Posttraumatic Renal Failure
Acute
Chronic

Post-procedural Renal Failure
Acute
Chronic

Renal Insufficiency
Acute
Chronic

Azotemia (meaning uremia)
Chronic
Prerenal
Extrarenal



Nephropathy
Diabetic
Toxic
SLE
Amyloid
Hypertensive
Other diagnosis (please specify)*

Interstitial nephritis

Glomerulonephritis (please specify)*

Unable to determine

Other diagnosis (please specify)*









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

evanspx@sutterhealth.org

arozhkovskaya

Thank you again, Paul. I will share it with my team. This is good query template.

catladyrn

I completely agree with Paul. I teach my team to query if the docs have written acute kidney disease or acute on chronic kidney disease, because acute kidney disease codes to "disorder of kidney and ureter." Acute on chronic kidney disease is a misnomer anyway (see CC 3Q2010), and although we understand what the physician meant, we have to use what they actually said.

Renee

Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
Director, Clinical Documentation
Tanner Health System

cjschaefer

Hi Paul,
I would like to query for posttraumatic renal failure when there is an opportunity. What makes me uncomfortable to include this in the response choices is that it is an MCC, so I imagine it must need more intense clinical indicators. It codes to posttraumatic anuria - does the patient have to be anuric? I can't find clinical indicators for it. I look forward to your guidance and thoughts. 
Thank you!
Carmi

evanspx@sutterhealth.org

Hi, Carmi

I just saw your posting.  To be honest, 99% of my query opportunities regarding potential acute renal failure occur in the settings of contrast, sepsis, dehydration, or poisoning, etc.,

I note the index describes both acute and chronic postprocedural renal failure as N99.0 with an additional code to describe the type of kidney disease.   So, the code N99.0 is not an MCC, the additional code for the type of renal failure may or may not be a CC or MCC.  

In a query, I’d suggest you ask if the ‘renal disease’ is associated with the potential procedure.  

cjschaefer

Hi Paul,

Thank you so much for your reply!

My apologies for not mentioning that this is for trauma cases who have AKI. I would like to add posttraumatic renal failure to my Query Response choices for AKI specificity/cause (ATN, prerenal, vasomotor nephropathy, etc....).

I need help with clinical indicators for posttraumatic renal failure (codes to posttraumatic anuria), which is an MCC. 

Thank you!

cjschaefer

Hi Paul,

Just an additional info - When I enter Posttraumatic Renal Failure in the 3M Encoder - it gives me T795XXA....
Thank you!

Carmi

evanspx@sutterhealth.org

Anuria, Post Procedural, codes to N99.0: neither a CC nor MCC, and requires a SECONDARY code to report the precise type of any additional renal failure

Anuria, Following Crushing Injury, codes to T79.5XXA, and this is an MCC.  I have not seen this much at all in my work to be honest.  I have not researched the indicators, but it follows to me that a lack of urine production (anuria) following a crushing injury is the diagnostic criteria. 

There are clinical citations for 'anuria' and 'anuria due to injury' on the web, but I am having issues with my cope and paste.

As far as indicators for AKI and ATN, I personally advocate for KDIGO.

If you want more detailed information on the criteria I personally use, please write me

evanspx@sutterhealth.org, as this forum is limited.

Paul Evans, RHIA, CCDS

cjschaefer

Hi Paul,

This is great info from you. I will keep this in mind for crushing injuries and if anuric among other indicators.
Thank you so much for your input and advice on this!

Carmi

evanspx@sutterhealth.org

Hi, Carmi
Thank you for the question. I have not thought about anuria following crushing injury, and this could help me in my workflow.  I tend to ‘always’ think about acute renal disease in the typical settings of other processes that are more common.

Paul