Q&A: Principal diagnosis selection for patient with CKD, ARF

Q: Our team is having a hard time determining a principal diagnosis for a patient with a history of stage 5 chronic kidney disease (CKD) who is receiving chronic hemodialysis and is in acute renal failure (ARF) with volume overload. The patient was admitted to receive the hemodialysis. What ICD-10-CM code should be listed as the principal diagnosis?

A: The principal diagnosis would be the ARF, which is captured with ICD-10-CM code N17.9 (acute kidney failure, unspecified).

The principal diagnosis is assigned based on either the underlying disease or the reason the patient was admitted for dialysis.

Although the patient has a history of CKD, the hemodialysis admission is due to the ARF/injury, which is accompanied with volume overload as a symptom of the ARF.

Editor’s note: Sarah Humbert, RHIA, AHIMA-certified ICD-10-CM/PCS trainer, coding and compliance manager at KIWI-TEK, LLC, and Temeka Davis, RHIT, coding manager at KIWI-TEK, LLC, answered this questions during HCPro’s webinar Acute Kidney Injury and Acute Renal Failure: 2018 Coding, Criteria, and Classifications.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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