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

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

Also known as:

Acute on Chronic Kidney DiseaseAcute Exacerbation of Chronic Renal Insufficiency

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Related ICD-10 Code Ranges

Complete code families applicable to Acute on Chronic Renal Insufficiency

N17-N19Primary Range

Acute kidney failure and chronic kidney disease

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

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 present without further specification.
  • Increase in serum creatinine by ≥0.3 mg/dL within 48 hours
  • Urine output <0.5 mL/kg/hr for 6 hours
N18.9Chronic kidney disease, unspecifiedUse when chronic kidney disease is present but not further specified.
  • GFR <60 mL/min/1.73 m² for 3 months or more

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 insufficiency?

Essential facts and insights about Acute on Chronic Renal Insufficiency

Code N17.9 for acute kidney failure and N18.x for chronic kidney disease, sequencing acute first. Ensure documentation specifies both conditions with lab values.

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

N17.9
Acute kidney failure, unspecified
Billable Code

Decision Criteria

clinical Criteria

  • Presence of acute kidney injury indicators such as elevated creatinine.

Applicable To

  • Acute renal failure

Excludes

  • Chronic kidney disease (N18.-)
  • End stage renal disease (N18.6)

Clinical Validation Requirements

  • Increase in serum creatinine by ≥0.3 mg/dL within 48 hours
  • Urine output <0.5 mL/kg/hr for 6 hours

Code-Specific Risks

  • Incorrectly coding when chronic kidney disease is also present.

Coding Notes

  • Ensure documentation specifies acute nature to avoid defaulting to unspecified codes.
View Full Code Details

Ancillary Codes

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

Complications of transplanted kidney

T86.1-
Use when acute kidney injury occurs in a transplanted kidney.

Differential Codes

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

Unspecified kidney failure

N19
Use N19 when neither acute nor chronic kidney failure can be specified.

Chronic kidney disease, stage 3

N18.3
Use N18.3 when CKD stage 3 is documented.

Documentation & Coding Risks

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

Impact

Clinical: Misrepresentation of patient's acute condition., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials due to unspecified coding.

Mitigation Strategy

Always document acute changes in renal function., Use specific terms like 'acute kidney injury'.

Impact

Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.

Mitigation Strategy

Use N17.9 for acute and N18.x for chronic, sequencing acute first.

Impact

Failing to sequence acute conditions before chronic conditions.

Mitigation Strategy

Educate coders on sequencing rules and provide examples.

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 Insufficiency, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Acute on Chronic Renal Insufficiency

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

Acute on Chronic Renal Insufficiency

Specialty: Nephrology

Required Elements

  • Acute kidney injury superimposed on chronic kidney disease stage [X]
  • Baseline creatinine: [value] mg/dL
  • Current creatinine: [value] mg/dL
  • Urine output: [value] mL/kg/hr

Example Documentation

Patient presents with acute on chronic renal insufficiency. Baseline creatinine 1.2 mg/dL, current 2.8 mg/dL. Urine output 0.3 mL/kg/hr over 8 hours.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Renal function worsened.
Good Documentation Example
Acute on chronic renal insufficiency: Cr increased from 1.2 to 2.8 mg/dL (133% rise) over 48hrs despite 2L NS bolus, urine output 0.3mL/kg/hr × 8hrs. Baseline CKD stage 3a (GFR 45)
Explanation
The good example provides specific lab values and CKD staging, which are necessary for accurate coding.

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