Re: Suspected Renal Pathology diagnosis for AKI (resend)
Don't have a query template, but do caution to first identify some clinical indicators that suggest ATN as opposed to blanket query. One of the first that comes to mind is the time frame of recovery of renal function -- if less than 36/48 hours, suggests more ARF/AKI from prerenal causes. Look for nephro toxic agents (iv contrast), sepsis, significant volume depletion or hypotension, etc. As I recall, casts in UA also suggest, also fractional excretion of Na (though watch that lab study is done prior to significant fluid resuscitation).
This link is very helpful:
http://emedicine.medscape.com/article/238064-print
I am attempting to attach a pdf of that article.
Edit -- doesn't seem to go through with attachment......
Don
Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com
Never give in. Never, never, never, never--in nothing, great or small, large or petty--never give in, except to convictions of honor and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy
Sir Winston Churchhill
>>> "CDI Talk" 12/27/2010 2:23 PM >>>
Does anyone have a query template sheet for asking the physicians to be more specific about the suspected renal pathology for a Dx of AKI? For example, The suspected cause of AKI might be Acute Tubular Necrosis (ATN) which is an MCC and would better reflect the severity of illness and mortality risk. If so, would you be willing to share with the group?
Thank you,
Barbara Lefevre RN BSN CCDS
Saint Mary's Hospital
Waterbury, Connecticut
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This link is very helpful:
http://emedicine.medscape.com/article/238064-print
I am attempting to attach a pdf of that article.
Edit -- doesn't seem to go through with attachment......
Don
Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com
Never give in. Never, never, never, never--in nothing, great or small, large or petty--never give in, except to convictions of honor and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy
Sir Winston Churchhill
>>> "CDI Talk" 12/27/2010 2:23 PM >>>
Does anyone have a query template sheet for asking the physicians to be more specific about the suspected renal pathology for a Dx of AKI? For example, The suspected cause of AKI might be Acute Tubular Necrosis (ATN) which is an MCC and would better reflect the severity of illness and mortality risk. If so, would you be willing to share with the group?
Thank you,
Barbara Lefevre RN BSN CCDS
Saint Mary's Hospital
Waterbury, Connecticut
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: dbutler@pcmh.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-10658493.d7a78f19df027783a773a709a7d013d4@hcprotalk.com
---
Copyright 2010
HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
------------------------------------------------------------------------------
The contents of this e-mail (and any attachments) are confidential, may be privileged and may contain copyright material. You may only reproduce or distribute material if you are expressly authorized by us to do so. If you are not the intended recipient, any use, disclosure or copying of this email (and any attachments) is unauthorized. If you have received this e-mail in error, please notify the sender and immediately delete this e-mail and any copies of it from your system.
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Comments
I'm actually pretty uncomfortable querying for ATN. Internal medicine isn't going to feel they can document it without input from renal, and renal generally knows what they are looking at and don't need my help in coming up with a diagnosis. What I do query is when they write ATN or suspected and then the diagnosis drops off to only AKI. Is the ATN resolving or was it never there?
Renee
Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center