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ICD-10 Coding for Acute on Chronic Renal Disease(N17.9, N18.30)

Complete ICD-10-CM coding and documentation guide for Acute on Chronic Renal Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Acute on Chronic Kidney DiseaseAcute on Chronic Renal Failure

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Related ICD-10 Code Ranges

Complete code families applicable to Acute on Chronic Renal Disease

N17-N19Primary Range

Acute kidney failure and chronic kidney disease

This range includes codes for both acute kidney injury and chronic kidney disease, which are essential for coding acute on chronic renal disease.

I12-I13

Hypertensive kidney disease

Relevant when hypertension is a contributing factor to chronic kidney disease.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
N17.9Acute kidney failure, unspecifiedUse when acute kidney injury is documented without further specification.
  • Serum creatinine increase ≥0.3 mg/dL or 1.5x baseline within 48 hours
  • Urine output <0.5 mL/kg/hr for >6 hours
N18.30Chronic kidney disease, stage 3 unspecifiedUse when CKD stage 3 is documented without further specification.
  • GFR 30-59 mL/min/1.73m²

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: How do you code acute on chronic renal disease?

Essential facts and insights about Acute on Chronic Renal Disease

Code both acute kidney injury (N17.9) and the stage of chronic kidney disease (N18.x). Ensure documentation specifies 'acute on chronic renal failure'.

Primary ICD-10-CM Codes for acute on chronic renal disease

N17.9
Acute kidney failure, unspecified
Billable Code

Decision Criteria

clinical Criteria

  • Documented acute rise in creatinine levels.

documentation Criteria

  • Explicit mention of 'acute on chronic renal failure'.

Applicable To

  • Acute renal failure

Excludes

  • Chronic kidney disease (N18.-)

Clinical Validation Requirements

  • Serum creatinine increase ≥0.3 mg/dL or 1.5x baseline within 48 hours
  • Urine output <0.5 mL/kg/hr for >6 hours

Code-Specific Risks

  • Risk of undercoding if chronic kidney disease is not also coded.

Coding Notes

  • Ensure acute and chronic conditions are documented and coded separately.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Dehydration

E86.0
Use when dehydration is the cause of acute kidney injury.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Disorder of kidney and ureter, unspecified

N28.9
Use N28.9 when renal insufficiency is documented without specification of acute or chronic.

Chronic kidney disease, unspecified

N18.9
Use N18.9 when CKD is documented without stage.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Acute on Chronic Renal Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N17.9.

Impact

Clinical: Leads to unspecified coding., Regulatory: Non-compliance with ICD-10 guidelines., Financial: Potential for reduced reimbursement.

Mitigation Strategy

Educate providers on the importance of specificity., Implement documentation audits.

Impact

Reimbursement: May lead to lower DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.

Mitigation Strategy

Ensure documentation specifies 'acute kidney injury'.

Impact

Failure to document both acute and chronic conditions.

Mitigation Strategy

Regular training and audits.

Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.

Frequently Asked Questions

Common questions about ICD-10 coding for Acute on Chronic Renal Disease, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Acute on Chronic Renal Disease

Use these documentation templates to ensure complete and accurate documentation for Acute on Chronic Renal Disease. These templates include all required elements for proper coding and billing.

Acute on chronic renal failure due to dehydration

Specialty: Nephrology

Required Elements

  • Patient demographics
  • CKD stage
  • Acute symptoms
  • Lab trends
  • Causal relationship

Example Documentation

Patient with Stage 3 CKD presents with acute worsening of renal function (creatinine increased from 1.5 to 2.8 mg/dL) secondary to dehydration.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Renal function worsened.
Good Documentation Example
Acute kidney injury superimposed on Stage 3 CKD: Creatinine increased from 1.2 to 2.1 mg/dL (1.75x baseline) over 48 hours with oliguria.
Explanation
The good example specifies the acute condition, CKD stage, and provides lab data.

Need help with ICD-10 coding for Acute on Chronic Renal Disease? Ask your questions below.

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