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

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

Also known as:

Acute on CKDAcute Kidney Injury on Chronic Kidney Disease

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Related ICD-10 Code Ranges

Complete code families applicable to Acute on Chronic Kidney Disease

N17-N19Primary Range

Acute and chronic kidney failure

This range includes codes for acute kidney injury (AKI) and chronic kidney disease (CKD), which are essential for coding acute on chronic kidney disease.

N18

Chronic kidney disease (CKD)

This range is used to specify the stage of chronic kidney disease, which is crucial for accurate coding of acute on 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 present without a specified cause or subtype.
  • Increase in serum creatinine by ≥0.3 mg/dL within 48 hours or 1.5 times baseline
  • Reduced urine output <0.5 mL/kg/h for 6 hours
N18.30Chronic kidney disease, stage 3 unspecifiedUse to specify the stage of CKD when stage 3 is documented without further specification.
  • GFR 30-59 mL/min/1.73m² for more than 3 months

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 kidney disease?

Essential facts and insights about Acute on Chronic Kidney Disease

Code acute on chronic kidney disease by sequencing the acute kidney injury (N17.9) first, followed by the chronic kidney disease stage (N18.x).

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

N17.9
Acute kidney failure, unspecified
Billable Code

Decision Criteria

clinical Criteria

  • Presence of acute kidney injury superimposed on chronic kidney disease.

Applicable To

  • Acute renal failure

Excludes

  • Chronic kidney disease (N18.-)

Clinical Validation Requirements

  • Increase in serum creatinine by ≥0.3 mg/dL within 48 hours or 1.5 times baseline
  • Reduced urine output <0.5 mL/kg/h for 6 hours

Code-Specific Risks

  • Risk of undercoding if specific cause of AKI is documented but not coded.

Coding Notes

  • Ensure documentation specifies 'acute on chronic' to avoid coding errors.
View Full Code Details

Ancillary Codes

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

Type 2 diabetes mellitus with diabetic chronic kidney disease

E11.22
Use when diabetes is a contributing factor to CKD.

Hypertensive chronic kidney disease without heart failure

I12.9
Use when hypertension is a contributing factor to CKD.

Differential Codes

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

Acute kidney failure with tubular necrosis

N17.0
Use when acute tubular necrosis is documented as the cause of AKI.

Chronic kidney disease, stage 3a

N18.31
Use when GFR is 45-59 mL/min/1.73m².

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Acute on Chronic Kidney 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: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential loss of reimbursement for higher severity stages.

Mitigation Strategy

Ensure CKD stage is documented in every patient encounter., Use templates that prompt for CKD staging.

Impact

Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases the accuracy of clinical data.

Mitigation Strategy

Review documentation for specific causes of AKI and use more specific codes.

Impact

AKI should be sequenced first if it is the primary focus of treatment.

Mitigation Strategy

Educate coding staff on proper sequencing rules.

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

Documentation Templates for Acute on Chronic Kidney Disease

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

Acute on chronic kidney disease in a nephrology clinic

Specialty: Nephrology

Required Elements

  • Patient history
  • Current medications
  • Lab results (serum creatinine, GFR)
  • Assessment and plan

Example Documentation

Patient presents with acute kidney injury on chronic kidney disease stage 3. Serum creatinine increased from 1.8 to 2.7. Plan includes IV fluids and holding nephrotoxic medications.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has kidney issues.
Good Documentation Example
Patient with CKD stage 3 presents with AKI, serum creatinine increased from 1.8 to 2.7.
Explanation
The good example provides specific details about the CKD stage and the acute change in kidney function.

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

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