Q & A: A Coding conundrum for CKD

Q: Dear Donal, connecting for health are telling our coders that the term CKD is not acceptable. To quote:
“I am afraid we have a problem with our Local Policy with you and your team around the stages of CKD, when it is stated on the discharge summary/case notes CKD 1 – 5.
Connecting for Health have informed us that we are unable to assign Chronic Kidney Failure codes to this abbreviation as it is not a mandated instruction in our ICD 10 Clinical Coding Manual (please see attachment above). This means that without the term ‘kidney failure’ written on the discharge summary (which is our source documentation for coding) we can not code CKD as kidney failure.”

Clearly we cannot go back and uneducate all our docs to stop using terms like CKD or AKI. Can you sort out Connecting for Health? Kerry Tomlinson

A: Dear Kerry, thank you for your email highlighting the difficulties you are having in Stoke capturing the coding on Chronic Kidney Disease because of the lack of codes within the current version of ICD-10. I too have taken some advice from the comorbidity coding group within Connecting for Health and on the basis of their advice suggest the following;

First we are assured that version 4 of ICD-10 will contain specific codes and guidance for chronic kidney disease and it's stages. Version 4 will be implemented in the NHS from April 2012 and should provide a robust means of capturing CKD in clinical coding.

Until April 2012 we need to work with the existing ICD-10 codes, which as you appreciate do not contain CKD codes or indeed terribly satisfactory means of capturing CKD using existing chronic renal failure coding. CfH have suggested the following "work around";

"The term Chronic Kidney Disease (CKD), when referring to CKD with stages 1-5 does not exist in the current mandated version of ICD-10.
However at present, for consistency, we must follow the existing index trail for a documents diagnosis of chronic kidney disease, which is:

Disease
- kidney (functional) (pelvis) (see also Disease, renal)
Disease
- renal
- - chronic – see nephritis, chronic
Nephritis, nephritic
- chronic N03.-
N03 Chronic nephritic syndrome
(Fourth character assignment will depend on the additional information
provided in the casenotes.)
As stated by the note on page 680 of ICD-10 Volume 1; an additional
code must be used to identify the external cause (chapter XX) or the
presence of renal failure (N17-N19).

Please note that the presence of renal failure is not always recorded in the patient care record when the clinician has stated that the patient has CKD, and it is not the responsibility of the coder to determine whether a patient has renal failure based on the stage of the chronic kidney disease. Therefore, coders must liaise with their Trust renal physicians on this matter, to ensure that the relevant information is recorded in the patient care record."

In practice I think what it comes down to most is you agreeing a local system where clinicians, aware of the coding restrictions, and coders familiar with their clinicians practice come to a consensus on making the coding work for you for the next 12 months.

I hope that this information is helpful; CfH are well aware of the deficiency in the current coding structure and hence the planned change to a system enabling coding it correctly. Donal