Q&A: Reporting CHF, ESRD with volume overload

Q: We have a patient admitted with a history of chronic heart failure (CHF) and end-stage renal disease (ESRD) who was admitted with volume overload due to acute kidney injury (AKI) and dialysis noncompliance. The AKI and volume overload resolved with hemodialysis treatment. How should we report this in ICD-10-CM?

A: Based on a previous Coding Clinic for ICD-9, although volume overload is a symptom of CHF, when the documentation specifically states that the volume overload is due to dialysis noncompliance and treated with hemodialysis, the volume overload would be coded as the principal diagnosis followed by the codes for CHF (found in ICD-10-CM code category I50.-) and noncompliance with dialysis (Z91.15).

If the patient is also documented as having AKI with volume overload, coding guidelines state that the AKI would be coded first followed by the codes for volume overload: CHF (chronic or unspecified), ESRD (N18.6), and dialysis noncompliance.

Also, the ICD-10-PCS procedure codes for the hemodialysis would be assigned based on the duration of the session or individual sessions of hemodialysis received. These can be found in ICD-10-PCS table 5A1 and include codes such as 5A1D70Z (Performance of urinary filtration, intermittent, less than 6 hours per day), 5A1D80Z (Performance of urinary filtration, prolonged intermittent, 6-18 hours per day), and 5A1D90Z (Performance of urinary filtration, continuous, greater than 18 hours per day).

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.

Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.