Health Information Management

Use kidney key-words to sooth your documentation troubles

CDI Strategies, April 2, 2009

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Many physicians fail to document conditions associated with acute kidney injury (AKI) and chronic kidney disease (CKD). These two conditions represent some of the strongest predictors of morbidity, mortality, and resource utilization in severity and risk-adjustment methodologies, and are integral to pay-for-performance indicators, says James S. Kennedy, MD, CCS, director at FTI Healthcare Inc., in Brentwood, TN.
“Instead, we use nonspecific (and lower-weighted) terms, such as azotemia or renal insufficiency. Sometimes, we don’t document anything at all,” Kennedy says.
However, even a mild serum creatinine rise (0.5 mg/dl) consistent with AKI is associated with a three-and-a-half day increase in inpatient length of stay and nearly $7,500 in excess hospital costs, according to a 2005 report from the University of California at San Francisco (UCSF).
Medicare weights its MS-DRGs based on the certain stages of kidney impairment. For example, documented chronic renal insufficiency adds no weight to an MS-DRG whereas Stage 4 and 5 CKD are designated as higher-weighted co-morbidities or complications (CCs) and end-stage renal disease (ESRD) qualifies as a major CC (MCC). Acute renal insufficiency or prerenal azotemia adds no weight, whereas AKI qualifies as an MCC.
Many physicians describe acute rises of creatinine as prerenal azotemia or acute renal insufficiency, even if the definition of AKI is met and resources described in the above UCSF article are used. Severity of illness is better defined with AKI term instead of azotemia or insufficiency, Kennedy notes..
But “of course, none of this matters unless [physicians] document these terminologies in the medical record, especially our discharge summaries, and work with our coding staff to defend these definitions when held accountable by outside auditors,” he says.

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