AKI and ATN documentation

Hello all,

We have been having discussion with our coding staff regarding the coding of "Possible ATN" documented by nephrology, but it is only documented as AKI by the attending. Would you consider this as conflicting documentation? Code the ATN as long as it's carried through to the day of discharge by the nephrologist? Need the attending to document the "Possible ATN" in the discharge summary for it to be coded? Query the attending for ATN?

We appreciate any input on this. Thanks!


  • We do query in those instances.  The auditors would likely jump all over that!
  • I’d query, too;  a consultant documented only possible ATN and the attending documented a term which is coded in a different fashion...acute kidney injury.  

    BTW, it is also relevant to note the term “AKI” does not automatically code to N17.9 as this may mean ‘Acute kidney insufficiency.

    Paul Evans, RHIA, CCDS
  • Anyone having experience with the new nomenclature of acute tubular injury?
    Our nephrologists are now using this term in place of ATN.  At the present time, I always query for ATN as well but I was wondering whether anyone is coding ATI as ATN.  Any advice on this?
  • Acute tubular injury is actually an older term that was proposed which better captures the diagnosis, as necrosis is actually rarely present in this disease process (Pinson, 2018). Our nephrologists still use acute tubular necrosis. I would probably continue to query to clarify the diagnosis as ATN in case of audit, as there is no mention of tubular injury in the tabular list that I could find. 

  • I would agree that a query is necessary especially since it seems that the attending and nephrologist do not agree. Sometimes an attending physician feels they don't have to document the consultants diagnosis as the consultant is doing that...little do they realize what happens when this occurs.  If the attending is uncomfortable they can always state Dr. x was consulted and his diagnosis was y which doesn't mean he disagreed he is stating what the consultants diagnosis was. 
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