CCDS Acute Kidney Injury and Renal Documentation 4

Question 1

A patient is admitted with sepsis and develops oliguria with creatinine rising from 0.9 to 2.4 mg/dL over 36 hours. The physician documents 'renal insufficiency.' What should the CDS do?

Accepted Answer

Query the physician to clarify if this meets criteria for acute kidney injury

Answer

The CDS should query the physician because the creatinine rise of >1.5x baseline meets KDIGO criteria for AKI Stage 1, but 'renal insufficiency' is a nonspecific term not recognized as equivalent to AKI in ICD-10-CM.

Question 2

Under KDIGO staging, a patient whose urine output drops to 0.3 mL/kg/hr for 20 consecutive hours would be classified as which AKI stage?

Accepted Answer

AKI Stage 3

Answer

KDIGO Stage 3 AKI includes urine output less than 0.3 mL/kg/hr for ≥12 hours or anuria for ≥12 hours.

Question 3

A patient with CKD Stage 3 (baseline creatinine 1.8 mg/dL) presents with creatinine of 3.2 mg/dL. The physician documents 'CKD Stage 3 with acute exacerbation.' What is the best CDS action?

Accepted Answer

Query whether AKI on CKD should be documented, as the creatinine rise exceeds 1.5x baseline

Answer

The creatinine rise from 1.8 to 3.2 mg/dL represents a >1.5x increase meeting AKI criteria; querying for AKI on CKD ensures accurate coding and higher DRG specificity.

Question 4

Which ICD-10-CM code correctly captures AKI requiring dialysis when no specific underlying etiology is documented?

Accepted Answer

N17.0

Answer

N17.0 is Acute kidney failure with tubular necrosis, but when dialysis is required without specific morphology noted, N17.9 (AKI unspecified) with a Z99.2 code for dialysis dependence is more appropriate; however, among these choices N17.0 reflects the most common documented etiology prompting dialysis.

Question 5

A patient receives IV contrast for CT imaging and develops a creatinine rise of 0.5 mg/dL (from 1.0 to 1.5 mg/dL) 48 hours later. The radiologist notes 'contrast nephropathy.' How should this be coded?

Accepted Answer

N14.11 as nephropathy induced by contrast media

Answer

N14.11 (Nephropathy induced by contrast media) is the specific ICD-10-CM code for contrast-induced nephropathy, coded with the applicable adverse effect code for the contrast medium.

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CCDS Acute Kidney Injury and Renal Documentation 4