Coding, Classification & Reimbursement

Type 1 IDDM resolved with Pancreas Transplant

  • 1.  Type 1 IDDM resolved with Pancreas Transplant

    Posted 15 days ago

    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. 

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  • 2.  RE: Type 1 IDDM resolved with Pancreas Transplant

    Posted 13 days ago
    Hi Nelda. The Pyelonephritis and the Acute renal Failure are already complications involving the transplanted kidney. Also, even though a transplant was done I think it's still common to have chronic renal insufficiency especially since the transplant took place in 2010. For the gastroparesis, I personally wouldn't code it as diabetic because the IDDM resolved with the transplant. The gastroparesis is not resolved because the IDDM is.
    I hope I made a bit of sense and I would love to hear the input of others on this!

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    Nujaima Abdullah
    Inpatient Coder
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  • 3.  RE: Type 1 IDDM resolved with Pancreas Transplant

    Posted 13 days ago
    I agree with assigning a complication code for the transplanted kidney. Being that the patient had a diagnosis of acute on chronic kidney failure on a previous admission, I would not assume the patient had a current diagnosis of chronic renal insufficiency without looking at the creatinine and Bun. If their normal it’s not likely the CRI. Also, look to see if the nephrologist documented current baseline creatinine and BUN value for the current kidney status if elevated then yes I agree with assigning dx CRI. Far as the gastroparesis code it that condition is colon related. Assign hx of code for diabetes if no issues and a status code for the pancreas transplant. Hope this helps.

    Anthony Neal




  • 4.  RE: Type 1 IDDM resolved with Pancreas Transplant

    Posted 13 days ago
    Hi,
    Are you saying that once a patient has a transplanted kidney with subsequent AKI that the is AKI is already assumed as a complication of the transplant? I have seen where it’s documented that no rejection noted and that the AKI is due to dehydration . Thank you for you thoughts!!

    Sent from my iPh




  • 5.  RE: Type 1 IDDM resolved with Pancreas Transplant

    Posted 13 days ago
    I would say yes. I wouldn't code it as a rejection though(that's a different code) but the AKI can only be affecting the transplanted kidney. That's different from the CKD which is common to not have full function of the kidney after a transplant. In your case the patient also has pyelonephritis and sepsis. I would code it as infection of the transplanted kidney (PDX) with the sepsis and pyelonephritis as additional.

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    Nujaima Abdullah
    Inpatient Coder
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  • 6.  RE: Type 1 IDDM resolved with Pancreas Transplant

    Posted 11 days ago

    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 2nd 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. 

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  • 7.  RE: Type 1 IDDM resolved with Pancreas Transplant

    Posted 12 days ago
    In your case the patient has pyelonephritis which is infection of the kidney. If the patient has had AKI and the creatinine and Bun has returned to normal I would not assume the patient has CKD with physician documentation.

    Anthony Neal