by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA
Hemodialysis coding for FY2018 includes a major change to the Duration value for the code. However, there is far more than the duration of the treatment involved in the coding, with the actual length of time on dialysis not being the determining factor of the treatment type.
There are three different types of dialysis treatment:
- IHD, or Intermittent hemodialysis (3-5 hours per day and 3 to 7 days a week)
- PIRRT, or Prolonged intermittent renal replacement therapy (8-12 hours per day, several or all days a week)
- CRRT, or Continuous renal replacement therapy (24 hours a day)
Continuous Renal Replacement Therapy (CRRT) allows gradual fluid and solute removal, greater hemodynamic stability and a greater likelihood of kidney recovery as compared to standard intermittent hemodialysis in patients with acute renal failure. However, CRRT has disadvantages of the need for anticoagulation and specialized pre-manufactured solutions, along with the need to stop therapy to perform off-unit tests and procedures, causing overall higher costs, as cited in a BioMed Nephrology study from 2015*. Different equipment is also required for CRRT.
Prolonged intermittent renal replacement therapy (PIRRT), also called Sustained Low Efficiency Dialysis, or SLED, was determined in the same study to be a viable alternative for acute renal failure patients without the significant disadvantages of CRRT. It uses traditional dialysis equipment and methods but for a much longer length of time and at a slower rate.
Intermittent hemodialysis is performed for chronic renal failure or end stage renal disease. Durations are typically much shorter and the dialysis process is much more intense, as the patients are not critically ill. This is what we typically think of as dialysis.
Table 5A1 for Hemodialysis Coding
Table 5A1 is used to code hemodialysis, with the body system of D, Urinary. The names of the procedures are listed in the duration value, along with the typical, wide range of treatment times for the therapy. But, keep in mind that CRRT and PIRRT (or SLED) are used for acute renal failure and IHD is used for chronic renal failure/ESRD. The specific type of treatment is identified in the physician’s order as one of these three types. The method determines the code, not the length of time.
A question asked of me last week gives a perfect example of why time is not the determining factor. The question was: “Can I code CRRT for about 5 hours on a patient with acute renal failure? After 5 hours, the patient was made comfort care and then quickly passed away. The physician had ordered CRRT for this patient. Does 5 hours mean that this is Intermittent or do we code Continuous because that’s what the physician ordered?”
The answer is that the Duration value of 9, Continuous is coded. The patient received this therapy on the order of a physician, and until the order was changed to comfort care and the patient passed away. This is coded based on the type of therapy, not the actual duration. This patient was acutely ill and hemodialysis was not the treatment ordered for the patient.
*Abhijat Kitchlu, et al. Outcomes of sustained low efficiency dialysis versus continuous renal replacement therapy in critically ill adults with acute kidney injury: a cohort study. BioMed Central Nephrology 2015; 16:127. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522955/
Looking for a comprehensive and insightful review of the October 1, 2017 Code Updates? Consider Lynn’s online courses: ICD-10-CM Code Update and ICD-10-PCS Code Update available from Libman Education. Learn more here.