Coding, Classification and Reimbursement

Patient was diagnosed with type 1 IDDM in the 1990s.  As time passes patient develops diabetic gastroparesis and diabetic chronic renal failure. At some point he also had a gastric stimulator placed.   In 2010 patient had a left renal and pancreas transplant.  Patient was recently in our facility with the following diagnoses:  severe sepsis with pyelonephritis, acute on chronic renal failure, no stage documented, nausea and vomiting with gastroparesis, IDDM resolved with transplant.  Patient does not take insulin nor oral diabetic meds.   I have sent a query to the physician asking if the chronic renal failure diagnosis is the previous diagnosis prior to the renal transplant or if the chronic renal failure is new and involving the transplanted kidney.  I believe if the latter, the diagnosis would be complication involving the transplanted organ.  I haven't heard back from the attending yet but I still have a question about the gastroparesis.  Is this diabetic gastroparesis.  And is transplanted pancreas status the only diagnosis to link with the IDDM resolved.  Very interesting case.  Thanking everyone in advance. 

Thanks everyone for your help in this issue.  The physician answered my query and clarified that the patient did not have chronic renal failure in the transplanted kidney, so I did not code the chronic renal failure.  And further, I did code the acute renal failure as this was the organ failure per the attending.  Nancy Martilik was so helpful in sending me a note on Coding Clinic of 2^nd Quarter, 2001, page 16 which answered my question on the gastroparesis.  Thank you Nancy and everyone who responded.  This is wonderful way to resolve our questions.