Knowledge Base Article

Back in September, 2016, an article was published concerning coding acute renal failure with ESRD. (Click here to see that article.) In answering the question I stated that a question had been submitted to the AHA Coding Advisor regarding patients diagnosed with both acute renal failure and ESRD. I finally received an answer on 4/12/17 and have added an update to the question.

Q:

Can acute renal failure be coded (ARF) with end stage renal disease (ESRD). Our PA has advised us not to code ARF with ESRD. He stated that once a patient has developed ESRD their kidneys are basically dead and no longer have the capability to function or produce any urine output so therefore would not be able to go into acute failure.

A:

This makes total sense but as coders we have to follow the Official Coding Guidelines and instructions given in the AHA Coding Clinic. MMP has re-submitted this question to the AHA Coding Clinic Advisor for further clarification. For the time being, until we receive a response back from them, you should follow the instructions given in Coding Clinic 2nd Qtr. 2011 page 15. When both ARF and ESRD are both documented by the provider, code each condition separately.

Update – April 12, 2017
Confirmation was received from the AHA Coding Clinic Advisor. Continue to follow the instructions given in Coding Clinic 2nd Qtr. 2011 page 15. When both acute renal failure and ESRD are clearly documented in the record, both conditions are to be coded.