Coding, Classification & Reimbursement

Subject: Acute renal failure due to dehydration ICD 10

1.  Acute renal failure due to dehydration ICD 10

Posted 15 days ago

Would like to know how others are coding acute renal failure due to dehydration since ICD 10 conversion.  There has been recommendation by CDI to assign the N17.8, as it is noted as an underlying cause of the acute renal failure.  However, CC guidance from 2002 3rd Qu pg 21-22 guides us to assign the 584.9.  CC 2015 4th Qu pg 20 states that as long as nothing new is published in ICD 10 CM CC then the advice still stands that was published prior so coders are assigning the N17.9.   I'm not finding anything to support assigning the N17.8, would ARF due to dehydration be considered an "other"?   Has this come up at other facilities?     Thank you! 



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M Lane, RHIT
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2.  RE: Acute renal failure due to dehydration ICD 10

Posted 14 days ago
​I received an error on my last audit results for not listing ARF primary and dehydration secondary.  However, if I start with dehydration first, I can't get to ARF as primary.  If I start with ARF, I can type in the dehydration and end up with ARF as primary.  The Coding Clinic 3rd Quarter 2002 was referenced.  We use 3M.  What does everyone else think???  Thank you.

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Nelda Laskey
RAC Coordinator/Coder
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3.  RE: Acute renal failure due to dehydration ICD 10

Posted 14 days ago

Hi,

 

I assume you are talking about the encoder not getting you where you want.  That is the down side of the encoder and I see that more in ICD 10 since there are more codes..the encoder was always supposed to be a tool but you may have to refer back to the book...even online book.

 

Sharon Hekimian, RHIT CCS                                                                

HIM Coder

PH #  781-453-5215

HOME OFFICE  # 617-312-9205

FAX # 781-453-5783 ATTN: SHARON

 






4.  RE: Acute renal failure due to dehydration ICD 10

Posted 13 days ago
​I apologize that I wasn't more clear in my question.    We've been told that N17.8 affects the ROM by our CDI nurses, so they recommended if we see that acute renal failure, or acute kidney injury is secondary to dehydration, that we should be assigning the N17.8 versus the N17.9.   The coders have been following the ICD 9 guidance in CC 2002 3rd Qu, pg 21-22, which guided us to assign the acute renal failure, unspecified code, 584.9, thus in ICD10 CM code N17.9.

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M Lane
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5.  RE: Acute renal failure due to dehydration ICD 10

Posted 12 days ago
This is very intresting. I am intrested in what others think about this. I'm thinking that N17.9 would be correct for AKI due to dehydration. It's what caused the AKI , but not really the type of AKI?
Where I work we seem to have divided opinions on Fluid overload and specifically when to use N17.9 versus N17.8. I would love to hear how others are using these codes. 


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Ursula Zettlemoyer
Coding analyst
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6.  RE: Acute renal failure due to dehydration ICD 10

Posted 11 days ago
Hi all, I sent this question to Coding Clinic in June 2016 and was hoping they would publish it, but so far not yet. Their response was to code N17.9, that N17.8 is assigned when a physician documents a particular type of acute renal failure that is not described in the other codes in this category, not to be assigned for acute renal failure due to "something (another condition or symptom)". The N17.8 code increases SOI/ROM and CDI wants coders to use it because it will increase reimbursement. The .8 categories in the classification are for specific diagnoses and should rarely be assigned. This same question has been posed at least 6 times previously in Coding Clinic ICD-9 and instructions from Coding Clinic each time have been to not assign the .8 code. I have presented these Coding Clinics several times to no avail, we are instructed to assign the .8 code in my facility.

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Dianna Bethany
Coder
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7.  RE: Acute renal failure due to dehydration ICD 10

Posted 11 days ago
Edited by Laurie Zawiskie 11 days ago
Dianna - Are the CDI instructing you to assign the .8 or your coding manager? I don't understand how the consistent advice from Coding Clinic can be ignored even if it's not published. There seems to be a pattern on here lately of the CDI pushing for the higher reimbursement or SOI/ROM even if it doesn't follow guidelines. Isn't that called upcoding?


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Laurie Zawiskie
Coder III
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8.  RE: Acute renal failure due to dehydration ICD 10

Posted 6 days ago
​Dianna,
When you received your response back from AHA, did you receive a reference #.    The reason I'm asking is that in the past one of my co-workers received a reference#, and we could go in and refer back to that document, I believe we even printed it, to use in of why we coded the way we did on a case which was audited by an outside agency.      Thank you~


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Maria Lane
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9.  RE: Acute renal failure due to dehydration ICD 10

Posted 2 days ago
Hi Maria, I presented it and gave the reference number from my response and was told we would still be coding it N17.8, it's frustrating when we have definite instruction and it is ignored. What do you do?

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Dianna Bethany
RHIT, CCS, CDIP, ICD-10 Trainer
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10.  RE: Acute renal failure due to dehydration ICD 10

Posted yesterday
​Hi Dianna,
Yes, after further discussion we were also instructed to use the N17.8 until we see something published in Coding Clinic.   Would you be willing to share the reference number that you were given by AHA?    Thank you!

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Maria Lane
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11.  RE: Acute renal failure due to dehydration ICD 10

Posted 2 days ago
Hi Laurie, Both, yes it is upcoding, and I am documenting it every time I code it. I have no alternative.

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Dianna Bethany
RHIT, CCS, CDIP, ICD-10 Trainer
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