ARF Query?

ggoodman@virginiahospitalcenter.com

I greatly appreciate the ARF/AKI resources everyone shared yesterday!



I am having hard time getting docs to document the etiology of the ARF.



The way I understand it the following causes of ARF are MCCs

1) ATN (most common?)

2) Medullary Necrosis

3) Cortical Necrosis

4) Other specified pathological lesion



At my facility I keep seeing documented "ARF due to dehydration", and
"ARF likely pre-renal", etc.

I'm thinking about making an ARF query asking for the etiology but I'm
afraid that if I word it like that I will just continue getting "ARF
etiology-dehydration."

Any ideas on how to word a query like this or any query examples you
would be willing to share?

Are you querying all cases of ARF to see if they are due to ATN, etc?

Or how are you deciding which ARF cases to query?



Thanks!



Greta Goodman

Clinical Documentation Improvement Specialist

Health Information Management

Virginia Hospital Center

1701 North George Mason Drive

Arlington, VA 22205

703-558-5336

ggoodman@virginiahospitalcenter.com




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evanspx@sutterhealth.org

I would not query for ATN for all cases of ARF unless you see some of
the indicators referenced in the resources cited yesterday as Acute
Renal Failure w/o ATN is pretty common in dehydrated patients.



I would review for an abnormal FENA result and the abnormal urine
results per the citation below.



The original posting also stated the Serum Cr returns to normal faster
in ARF w/o ATN, and this can be a clue as well.



The ACDIS blog you cited has quite a bit of useful information you can
use to try to determine if/when to query for ATN - I would just bear
in mind that simple pre-renal ARF 584.9 is apparently more common than
ATN and if you query all of your ARF due to dehydration, you may
experience a lot of denials.



Acute tubular necrosis (ATN) is defined by acute kidney injury and
tubular damage in the absence of significant glomerular or vascular
pathology. Tubular casts, red cells, and protein may be seen in the
urinanalysis. If the offending agent is removed, the kidneys usually
repair themselves. (Robbins Pathology)



Paul Evans, RHIA, CCS, CCS-P

Supervisor, Clinical Documentation Integrity

California Pacific Medical Center

2351 Clay #243

San Francisco, CA 94115

Cell: 415.637.9002

Fax: 415.600.1325

Ofc: 415.600.3739

________________________________

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, July 29, 2011 12:21 PM
To: Evans, Paul
Subject: [cdi_talk] ARF Query?



I greatly appreciate the ARF/AKI resources everyone shared yesterday!



I am having hard time getting docs to document the etiology of the ARF.



The way I understand it the following causes of ARF are MCCs

1) ATN (most common?)

2) Medullary Necrosis

3) Cortical Necrosis

4) Other specified pathological lesion



At my facility I keep seeing documented "ARF due to dehydration", and
"ARF likely pre-renal", etc.

I'm thinking about making an ARF query asking for the etiology but I'm
afraid that if I word it like that I will just continue getting "ARF
etiology-dehydration."

Any ideas on how to word a query like this or any query examples you
would be willing to share?

Are you querying all cases of ARF to see if they are due to ATN, etc?

Or how are you deciding which ARF cases to query?



Thanks!



Greta Goodman

Clinical Documentation Improvement Specialist

Health Information Management

Virginia Hospital Center

1701 North George Mason Drive

Arlington, VA 22205

703-558-5336

ggoodman@virginiahospitalcenter.com



________________________________



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intended solely for the use of the individual or entity to whom they are
addressed. This communication may contain personal patient health care
information and is protected by federal law and other statutory
protections. If you are not the intended recipient or the individual
responsible for delivering the e-mail to the intended recipient, please
be advised that you have received this e-mail in error and that any use,
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attached files is strictly prohibited. If you have received this e-mail
in error, please promptly delete this message and notify the sender of
the delivery error by e-mail or you may call Virginia Hospital Center -
Arlington's Information Systems Department (+1)(703)558-6566.

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