Kidney failure

hillsandovals@email.chop.eduhillsandovals@email.chop.edu
in Pediatrics

Hello CDI, I have a question about coding kidney failure. I had a case where the doctor documented that a patient was a past Kidney transplant  (this yr) who came in with fluid overload, HTN, and diabetes, but never documented that the child was in Renal failure.

The coder coded the renal failure as the principal, and the CDI coded HTN as the principal.

The CDI's thought process was that since the doctor did not state that this pt was actually in renal failure, she could not assume that the pt was.

The coding manager stated that since the pt was a past transplant and that the clinical picture pointed to the kidney that the pt was in renal failure.....your thoughts.


Thanks,

Steph

Comments

  • morris-jeff@CooperHealth.edumorris-jeff@CooperHealth.edu
    Hi Steph, 
    We don't do transplants so maybe I'm missing some knowledge there if there are guidelines allowing for renal failure to be coded. But, if the clinical picture points to something that we don't have a Dx for, we query. Sounds like the coder needs some education but were there lab indicators of failure? If so,  the CDI should've queried for it while the pt was inhouse, so that might be an educational opportunity for them also. We use KDIGO criteria, not sure what your docs use. What was pts Cr?
    jeff
  • jackietouch@aol.comjackietouch@aol.com
    I would query for acute kidney injury/renal failure if the indicators and treatment are present.  I don't think it can be assumed that acute renal failure was present based on transplant status alone.

    Jackie
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    Can't not assume ARF is present - definitely check if criteria met for AKI and if so, query would be advised.  IF pt has documented ARF s/p renal transplant, the PDX =  T86.19 followed by the specific code for the type of Acute Kidney Injury. 
  • hillsandovals@email.chop.eduhillsandovals@email.chop.edu

    Hi Paul, Jeff and Jackie....that is what I thought. I am in the process of going back and forth with the coding manager.


    Thanks

    Steph 

  • 2270620822706208

    Hi

    There is also a chance that code T86,12 Kidney Transplant Failure would be the PDX in this case. Agree, a CDI query would clarify all.

    Thanks

    SCH

Sign In or Register to comment.