Accurate coding of kidney diseases like acute kidney injury with ICD-10 and CPT codes can have a measurable impact on reimbursement.

1. Documenting
Acute Kidney
Injury with
Accurate Medical
Codes
Accurate coding of kidney
diseases like acute kidney
injury with ICD-10 and CPT
codes can have a
measurable impact on
reimbursement.
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Acute kidney injury (AKI), also referred to as acute kidney failure or acute
renal failure, is a condition that occurs when your kidneys suddenly stop
filtering waste products from the blood. The condition is most common in
people who are already hospitalized, particularly in critically ill people who
need intensive care. It is also considered as a major risk factor for the
development of chronic kidney disease (CKD). Accurate medical coding
services for kidney disease are critical to ensure correct reimbursement for
patients and doctors.
The U.S. Department of Health and Human Services has explained the five
stages of kidney diseases as - kidney damage with normal kidney function,
kidney damage with mild loss of kidney function, mild-to-severe loss of
kidney function, and severe loss of kidney function and kidney failure
requiring dialysis or transplant for survival. Symptoms of acute renal failure
include shortness of breath, reduced urine output, irregular heartbeat,
fatigue, chest pain, and nausea. This acute condition occurs commonly in
older adults, and the incidence rises with age.
The causes of acute kidney injury or failure are classified into three
categories:
 Pre-renal: diminished blood flow to the kidneys or volume loss
 Intrinsic/renal: diseases and disorders of the kidneys
 Post-renal: bilateral obstruction of urinary outflow
The condition can be the result of decreased blood flow, direct damage to
kidneys, or blockage of urinary tract. Other conditions that can increase the
risk of acute kidney failure include blockages in the blood vessels in the arms
or legs, diabetes, high blood pressure, heart failure, kidney diseases, liver
diseases as well as certain cancers and their treatments.

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Diagnosis, Treatment and Coding for Acute Renal Failure
Certain tests and procedures that doctors may recommend to verify
diagnosis of AKI include urine tests, blood tests, imaging tests and testing
kidney tissue samples. Treatment options recommended by doctors depend
on what's causing the patient’s kidney failure. Certain treatments that are
provided to prevent complications include balancing the amount of fluids in
your blood, providing medications to control blood potassium, medicines to
restore blood calcium levels as well as dialysis to remove toxins from the
blood.
Diagnosis and accurate documentation of the causes of such kidney disease
in hospitalized patients can have a critical impact on treatment, length of
hospital stay, and long-term patient outcomes. Using the correct codes for
the treatment provided in medical claims is important from the
reimbursement point of view.
According to the CMS, AKI claims will require one of the following ICD-10
codes:
 S37.0 Injury of kidney
 N17.0 Acute kidney failure with tubular necrosis
 N17.1 Acute kidney failure acute cortical necrosis
 N17.2 Acute kidney failure with medullary necrosis
 N17.8 Other acute kidney failure
 N17.9 Acute kidney failure, unspecified
 T79.5XXA Traumatic anuria, initial encounter
 T79.5XXD Traumatic anuria, subsequent encounter
 T79.5XXS Traumatic anuria, sequela
 N99.0 Post-procedural (acute)(chronic) renal failure

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CPT code
G0491 - Dialysis procedure at a Medicare certified ESRD facility for acute
kidney injury without ESRD or just “Dialysis Acu kidney no ESRD”
Coding Tips for AKI
 In cases where patients are diagnosed with both acute renal failure
and end stage renal disease (ESRD), each condition needs to be coded
separately.
 While coding, if the clinical indicators for acute kidney failure are not
met, coders can ask the provider if AKI represents “acute kidney
insufficiency” (N28.9) as this is the early stage of renal impairment
before it evolves into renal failure.
 Never report acute renal insufficiency and acute kidney disease as
acute renal failure
The American Health Information Management Association (AHIMA)
guidelines are to document acute kidney injury (AKI) whether it is due to
traumatic injury or a non-traumatic event, and document whether acute
renal failure is due to acute tubular necrosis (ATN), acute cortical necrosis,
or acute medullary necrosis. Healthcare providers can rely on experienced
medical billing and coding companies to meet their documentation tasks
more efficiently.