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For other articles and previous issues click here. November 15, 2004 Coding
for Renal Failure Renal failure occurs when the kidneys are unable to eliminate excess fluid and waste material from the blood. There are three distinct conditions of renal failure: acute renal failure, chronic renal failure, and end stage renal disease (ESRD). Acute Renal Failure • contrast agents used in x-ray tests; • nonsteroidal anti-inflammatory drugs; and • antibiotics such as gentamicin, neomycin, or streptomycin. Most people who develop acute renal failure are already in the hospital, and therefore a code from category 584 is appropriately assigned as a secondary diagnosis. However, if a patient is admitted with acute renal failure due to an underlying cause, current coding advice states the acute renal failure may be sequenced as the principal diagnosis. For example, a patient is admitted with acute renal failure secondary to dehydration and was treated appropriately with IV fluids. The rehydration corrected the acute renal failure and the patient did not require dialysis. Code 584.9 would be sequenced as the principal diagnosis in this example with code 276.5, Dehydration, as a secondary diagnosis. “This would be consistent whether the acute renal failure was due to dehydration or another condition” (AHA Coding Clinic for ICD-9-CM, 2003, first quarter, page 22). In most instances, the acute renal failure is the more significant problem, which occasions the admission to the hospital. Therefore, since the admission is for treatment of the acute renal failure and not the underlying cause, it should be sequenced as the principal diagnosis (AHA Coding Clinic for ICD-9-CM, 2002, third quarter, page 28). Chronic Renal Failure If the patient has hypertension with a condition classifiable to category 585 (chronic renal failure), 586 (renal failure, unspecified), or 587 (renal sclerosis), assign a code from category 403, Hypertensive renal disease. Unlike hypertension with heart disease, ICD-9-CM presumes a cause-and-effect relationship and classifies renal failure with hypertension as hypertensive renal disease. This implied relationship is not the same if the patient has acute renal failure. If the patient has acute renal failure and hypertension, the conditions are coded separately (584.9 + 401.9) with sequencing depending on the circumstances of admission. When a cause-and-effect relationship is documented
between diabetes mellitus and chronic renal failure, the diabetic
code (250.4x) would be sequenced first followed by code 585. If the physician documents prerenal failure or prerenal azotemia, assign code 788.9. If the physician documents azotemia, assign code 790.6. However, it would be appropriate to query the physician for clarification if acute renal failure or chronic renal failure is present. ESRD • Hemodialysis (39.95) — blood is pumped from the body to an artificial kidney. Creation of a fistula between a vein and an artery is assigned to code 39.27, Arteriovenostomy for renal dialysis. This arteriovenous fistula or graft is often located in the wrist area between the cephalic vein and the radial artery. However, it can also be found in other parts of the arm or leg. Occasionally, a totally implantable vascular access device (86.07) is inserted for quick dialysis access to treat patients with renal failure. Code 38.95 is assigned if a venous catheter was inserted for the purpose of renal dialysis. • Peritoneal dialysis (54.98) — uses the blood vessels in the abdomen to filter the blood. A catheter is implanted into the abdomen and dialysate solution is infused into and drained out of the abdomen. Insertion of the peritoneal dialysis catheter (eg, Tenckhoff, Moncrief-Popovich) is assigned to code 54.93. Coding and sequencing for renal failure are dependent upon the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey Howard, RHIA, and Vicki Sippel, RHIA, of 3M Health Information Systems (800-367-2447), a leading supplier of coding and classification systems to nearly 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. |
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