Health Information Management

Q&A: Coding for transplant complications

JustCoding News: Inpatient, October 10, 2012

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Q: I have a question about coding transplant complications. My understanding is if the complication affects the transplanted organ, then coders should assign a code for the transplant complication itself. Is this correct?

Consider the following physician documentation: Final A/P: Acute renal failure in patient with history of renal transplant. Should coders report 996.81 (complications of transplanted kidney) and 584.9 (acute kidney failure, unspecified)?
 
Also consider this documentation: CHF in heart transplant patient. Should coders report 996.83 (complications of transplanted heart) and 428.0 (CHF, unspecified)?
 
A: When a condition affects a transplanted organ, coders should report a complication code as the first-listed diagnosis followed by a code for the type of complication. This is true even when the provider doesn’t document a relationship between the complication and the transplanted organ.
 
The ICD-9-CM Official Guidelines for Coding and Reporting, Section I.C.17.f.2.b, state the following:
 
Codes under subcategory 996.8, Complications of transplanted organ, are for use for both complications and rejection of transplanted organs. A transplant complication code is only assigned if the complication affects the function of the transplanted organ.
 
Coding Clinic also provides guidance regarding transplant complications. For example, Coding Clinic, 3rd quarter 1998 states the following:
 
When post-organ transplant patients present for further medical care, the coder must determine from the documentation whether the patient has any complications of the transplanted organ.
 
Several questions and answers in this same issue of Coding Clinic further clarify when coders should report a transplant complication code. They specifically address CHF in the transplanted heart (i.e., coders should assign 996.84 and 480.9 because the illness that the patient developed affected the transplanted organ) and acute renal failure in the transplanted kidney (i.e., coders should assign 996.83 and 428.0 for the same reason) and that code assignment isn’t affected by the fact that the patient had CHF prior to the transplant). The guidance demonstrates that providers don’t need to specifically define a condition as a complication of the transplanted organ.
 
The only caveat to my response relates to chronic kidney disease (CKD) and renal transplants. In some cases, the transplant may not fully restore kidney function. When this happens, coding guidelines state coders should “assign the appropriate 585 code for the patient’s stage of CKD and code V42.0 unless the documentation is unclear in which case the provider needs to be queried.” Guidelines further state the following:
 
Conditions that affect the function of the transplanted kidney, other than CKD, should be assigned code 996.81, Complications of transplanted organ, Kidney, and a secondary code that identifies the complication.
 
Editor’s note: Cheryl Ericson, MS, RN, CCDS, CDIP, CDI education director at HCPro, Inc. in Danvers, MA, answered this question.
 
This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
 
Need expert coding advice? Submit your question to Senior Managing Editor Michelle Leppert, CPC, at mleppert@hcpro.com, and we’ll do our best to get an answer for you.



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