ESRD vs CKD5

judithbatesjudithbates
edited May 2016 in CDI Talk Archive
This is a question from a fellow CDI that I thought would cause some interesting debate.

I would like to clarify coding compliance regarding CKD5 and ESRD.

Patient w/ history of diabetic nephropathy and CKD stage 5 (not on any form of dialysis yet) is admitted with HHNK, with AKI on CKD 5 also present at time of admission. Nephrology is consulted and writes AKI on CKD 5, does not need acute HD however will need placement of AV fistula for eventual dialysis. An AV fistula was placed on this admission, however no dialysis was initiated. Nephro consultant does not document ESRD, however other physicians (residents/ interns) on case documents ESRD and is cosigned by nephrologist. Creatinine came down to baseline with hydration.

My question is, in above scenario are we being compliant with coding ESRD for MCC (was not treated as ESRD since no dialysis)? Clinically speaking ESRD is the stage where a patient is on dialysis at least for 3 months (with no foreseeable return of renal function), whereas CKD 5 can be on or without dialysis (less than 6 months) and may even be reversed (like in case above).

Comments

  • Unknown
    edited May 2016
    Query...

    When I look 585.5 up in the encoder it has an excludes note of "chronic kidney disease, stage 5 requiring dialysis (585.6)."

    So, I would ask the attending or Nephro if you are coding the correct severity of the patient's CKD. Tell them you noticed that he docmented 5 but other MDs documented ESRD however no AHD initiated. Would that be CKD5 or ESRD?

    NBrunson, RHIA, CCDS
  • david.smithdavid.smith
    edited May 2016
    In your scenario, I would only code the CKD as stage 5. The code for ESRD is defined as "requiring dialysis" otherwise you are instructed to use the code for stage 5 CKD (585.5). This is different than the clinical determination where stage 5 and ESRD can be synonymous. According to the National Kidney Foundation the term ESRD is an administrative term in the US, not really a clinical term per se. A patient with ESRD (Stage 5) who is on dialysis is designated as Stage 5D (D denoting dialysis status).

    Here is a good link:
    http://www.kidney.org/professionals/kdoqi/guidelines_ckd/p4_class_g1.htm
  • Unknown
    edited May 2016
    Have they started HAD through a line?

    NTB
  • judithbatesjudithbates
    edited May 2016
    There is no dialysis during this admission, just placement of AVF for anticipated HD.

    Judi Bates RN, BSN, CCDS
    CDI Specialist
    856-757-3161
    Beeper 66x2906
  • laura.jansenlaura.jansen
    What if the physician documents ESRD, but the patient refuses dialysis. Would that go the CKD 5 even though dialysis is indicated but refused?
  • dvitalone1dvitalone1
    edited May 2016
    HOW FUNNY, I WAS JUST GOIN TO ASK THIS!!

    Dawn
  • murpca2murpca2
    edited May 2016
    It is my understanding that 585.5 (CKD-V) and 585.6 (ESRD) are both the same stage of kidney disease, end stage, the difference being one is on dialysis and one is not. The number difference is for reporting purposes and tracking. So, I would thing that if the patient is refusing dialysis, it would code to 585.5.

    Please let me know if this is not correct.
    Thanks


    Cathie Murphree LPN, CCDS
    Documentation Improvement Specialist/HIM
  • debbie.taylordebbie.taylor
    edited May 2016
    Can you have with ESRD and acute kidney failure? Or once you have ESRD you can no longer have an ARF episode even if you miss your dialysis or become ill and have a condition that say dehydrates you or causes you to miss your dialysis.
  • Unknown
    edited May 2016
    HCPro had a recent aucdio conference on Renal Failure.
    One of the questions raised was just this.

    Dialysis with any stage CKD goes to ESRD
    If a patient with ESRD refuses dialysis it still goes to ESRD


    Charlene
  • robert.hodges2robert.hodges2
    By definition, from the National Kidney Foundation, chronic is defined as greater than three months duration. So by the 44 day limit you describe, the definition of "chronic" is not met. If dialysis continues past 90 days then it would meet the definition of "chronic".

    Robert

    Robert S. Hodges, BSN, MSN, RN
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
  • Unknown
    edited May 2016
    According to our Nephros you can have Ac on Chr through CKD 4 but Stage 5/ESRD is not appropriate to ask for Ac on Chr.

    N. Brunson, RHIA/CCDS
  • elizabeth.hyndelizabeth.hynd
    edited May 2016
    Its hard without reviewing the chart and after 44 days no thank you, I do know clinically we dialyze for ARF and hope the renal function returns. I would not consider it CKD because they are on dialysis
  • catladyrncatladyrn
    I agree that I would not take ESRD just because a patient in ARF needs dialysis. We have patients with no previous renal hx going on CRRT or HD all the time because they became acutely ill after surgery. Unless the physician states those kidneys are permanently damaged beyond repair, I wouldn't go there.

    Renee


    Linda Renee Brown, RN, CCRN, CCDS
    Certified Clinical Documentation Specialist
    Banner Good Samaritan Medical Center
  • ssalinasssalinas
    edited May 2016
    ESRD and ARF are separate diagnoses and dialysis does not change that. Unfortunately in this day of multiple consultants, some physicians see that a patient is on dialysis and assume it is due to ESRD when in fact it is due to acute illness, toxicity or sepsis. Like Renee says below - can't go there.

    Sharon
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