Documenting Acute Kidney Injury with Accurate Medical Codes Accurate coding of kidney diseases like acute kidney injury with ICD-10 and CPT codes can have a measurable impact on reimbursement.
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Acute kidney injury (AKI), also referred to as acute kidney failure or acute renal failure, is a condition that occurs when your kidneys suddenly stop filtering waste products from the blood. The condition is most common in people who are already hospitalized, particularly in critically ill people who need intensive care. It is also considered as a major risk factor for the development of chronic kidney disease (CKD). Accurate medical coding services for kidney disease are critical to ensure correct reimbursement for patients and doctors. The U.S. Department of Health and Human Services has explained the five stages of kidney diseases as - kidney damage with normal kidney function, kidney damage with mild loss of kidney function, mild-to-severe loss of kidney function, and severe loss of kidney function and kidney failure requiring dialysis or transplant for survival. Symptoms of acute renal failure include shortness of breath, reduced urine output, irregular heartbeat, fatigue, chest pain, and nausea. This acute condition occurs commonly in older adults, and the incidence rises with age. The causes of acute kidney injury or failure are classified into three categories:
Pre-renal: diminished blood flow to the kidneys or volume loss
Intrinsic/renal: diseases and disorders of the kidneys
Post-renal: bilateral obstruction of urinary outflow
The condition can be the result of decreased blood flow, direct damage to kidneys, or blockage of urinary tract. Other conditions that can increase the risk of acute kidney failure include blockages in the blood vessels in the arms or legs, diabetes, high blood pressure, heart failure, kidney diseases, liver diseases as well as certain cancers and their treatments.
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Diagnosis, Treatment and Coding for Acute Renal Failure Certain tests and procedures that doctors may recommend to verify diagnosis of AKI include urine tests, blood tests, imaging tests and testing kidney tissue samples. Treatment options recommended by doctors depend on what's causing the patient’s kidney failure. Certain treatments that are provided to prevent complications include balancing the amount of fluids in your blood, providing medications to control blood potassium, medicines to restore blood calcium levels as well as dialysis to remove toxins from the blood. Diagnosis and accurate documentation of the causes of such kidney disease in hospitalized patients can have a critical impact on treatment, length of hospital stay, and long-term patient outcomes. Using the correct codes for the
treatment
provided
in
medical
claims
is
important
from
the
reimbursement point of view. According to the CMS, AKI claims will require one of the following ICD-10 codes:
S37.0 Injury of kidney
N17.0 Acute kidney failure with tubular necrosis
N17.1 Acute kidney failure acute cortical necrosis
N17.2 Acute kidney failure with medullary necrosis
N17.8 Other acute kidney failure
N17.9 Acute kidney failure, unspecified
T79.5XXA Traumatic anuria, initial encounter
T79.5XXD Traumatic anuria, subsequent encounter
T79.5XXS Traumatic anuria, sequela
N99.0 Post-procedural (acute)(chronic) renal failure
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CPT code G0491 - Dialysis procedure at a Medicare certified ESRD facility for acute kidney injury without ESRD or just “Dialysis Acu kidney no ESRD” Coding Tips for AKI
In cases where patients are diagnosed with both acute renal failure and end stage renal disease (ESRD), each condition needs to be coded separately.
While coding, if the clinical indicators for acute kidney failure are not met, coders can ask the provider if AKI represents “acute kidney insufficiency” (N28.9) as this is the early stage of renal impairment before it evolves into renal failure.
Never report acute renal insufficiency and acute kidney disease as acute renal failure
The
American
Health
Information
Management
Association
(AHIMA)
guidelines are to document acute kidney injury (AKI) whether it is due to traumatic injury or a non-traumatic event, and document whether acute renal failure is due to acute tubular necrosis (ATN), acute cortical necrosis, or acute medullary necrosis. Healthcare providers can rely on experienced medical billing and coding companies to meet their documentation tasks more efficiently.
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