Ranging CKD stages

tkreilingtkreiling
in CDI Talk Archive
Does anyone know of a coding clinic reference for the correct way to code a CKD stage that is documented as a range, ex. CKD 2-3 or CKD 3-4? I have been seeing this more lately and am not sure a query would be necessary as to me appears the doctor doesn't know for sure which stage, but was curious if others see this and if so how do you decide which stage to code.
Thanks.

Comments

  • robert.hodges2robert.hodges2
    edited May 2016
    I don't see this but my query form has the National Kidney Foundation guidelines attached to it. I would ask the provider to use the guidelines and to be specific. There is a tool for this on the ACDIS website in the Forms and Tools Library in the Physician Education Materials.

    The other question is if they are looking at an acute change, in which case you may have an acute insufficiency or failure on the chronic kidney disease. Per guidelines, for it to be chronic the change has to last at least 3 months.

    Robert

    Robert S. Hodges, BSN, MSN, RN
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
     
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov
     
    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
  • jolene.filejolene.file
    I have seen this documented.
  • Unknown
    edited May 2016
    I was taught that you would code to the highest level of specificity i.e. stage 2-3 you would code stage 3.

    However, I am unable to locate where this is in writing.

    If you have any doubt or the lab show a differing stage
    I'd agree with Robert, it would be good to query.


    Charlene
  • NormaBNormaB
    edited May 2016
    I've been searching through various coding references but caanot find where that is written. But we were always taught to code to the higher CKD Stage.

    I know basic coding rules state to code the deepest layer or the farthest debridement so it would follow logic this would be the higher stage.

    If I find something concrete I will post.

    NBrunson, RHIA,CCDS
  • johnsok5johnsok5
    edited May 2016
    We have this same problem with CKD staging and with some with other
    conditions like malnutrition where they document mild-moderate
    malnutrition or moderate-severe malnutrition. We will either query
    these cases or code to the lesser degree.

    We decided this type of documentation is unclear and could infer the
    patient meets criteria for say stage III CKD but hasn't quite crossed
    the threshold to meet stage IV. Same for malnutrition and other similar
    things.


    Sincerely,

    Karen A. Johnson

    DRG Assurance ext. 43559
  • johnsok5johnsok5
    edited May 2016
    We have this same problem with CKD staging and with some with other
    conditions like malnutrition where they document mild-moderate
    malnutrition or moderate-severe malnutrition. We will either query
    these cases or code to the lesser degree. We did write Coding Clinic
    and they stated essentially this type of documentation is unclear and
    could infer the patient meets criteria for say stage III CKD but hasn't
    quite crossed the threshold to meet stage IV. Same for malnutrition and
    other similar things.


    Sincerely,

    Karen A. Johnson

    DRG Assurance ext. 43559
  • ctrygarctrygar
    edited May 2016
    I asked the coders here and they said code to the highest level of specificity. ckd3-4 they would code 4
    They refer to coding clinic jan-feb 1986 level of specificity

    cheri
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