ESRD documentation after kidney transplant

rfoster@kdhcd.orgrfoster@kdhcd.org
in CDI Talk Archive
We have a situation where the patient had ESRD and then got a kidney transplant and the doctor is continuing to document ESRD but the new kidney is working fine. This doctor has informed me before that once a patient has ESRD they always have ESRD even if they get a new kidney. Is that true in the coding world? What are the rules for coding ESRD after a new kidney and especially if that new kidney is functioning? Thanks for any help you can give!!

Rebekah Foster RN BSN CCDS
Kaweah Delta Medical Center
400 W. Mineral King
Visalia, CA 93291
559624-5085

Comments

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    We can't report a current condition of ESRD if the pt has undergone successful transplant and the organ is not failing. You may assign a 'status' code to report that the patient has undergone transplant.

    If the transplanted kidney were to fail, then you would report any degree of 'current' CKD in the transplanted kidney.

    (How can one 'have' ESRD' always in such a situation if the organ functions fine and the GFR, et al, are normal - they can't, and we can't code as such).

    There are guidelines and Coding Clinics w/ formal advice, if you can search those files.



    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



  • rfoster@kdhcd.orgrfoster@kdhcd.org
    That is what I thought Paul. Thanks for your help! Just needed back up!!

    Rebekah Foster
  • m.leblancm.leblanc
    edited March 2016
    I think what many providers are speaking of is that the patient qualifies for ESRD coverage under CMS for his meds and such post-transplant and thus they are ESRD patients from that perspective. I agree that it does not correlate to the coding world but thought might shed some light on why they state always ESRD.

    Thanks,
    Mark

    MARK LEBLANC, RN, MBA, CCDS
    SENIOR CONSULTANT - CDI SERVICES

    952-353-3505
    m.leblanc@thewilshiregroup.net



  • don.cdi.rn@gmail.comdon.cdi.rn@gmail.com
    edited March 2016


    I'd also point out from a clinical perspective that the ESRD may still be
    described by the physician, with the thought that the renal failure
    treatment has transitioned from HD/PD to the functioning transplant. There
    remain clinical issues and concerns for these patients that change little
    post-transplant.

    However, agree with others, ESRD is no longer coded once transplanted and
    the organ is functioning adequately.

    Don

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