Health Information Management

Q&A: Two query alternatives for acute on chronic renal insufficiency

CDI Strategies, November 26, 2009

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Q: How I should query a physician when he documents: “Acute on chronic renal insufficiency secondary to dehydration” ?

A: I would recommend the following approach:

“The National Kidney Foundation (NKF) has developed staging for chronic kidney disease. In which stage would your patient fall? We see that the patient's creatinine, age, and race calculate to a stable GFR in the past of ___ ml/min, which corresponds to Stage ___.

Additionally, standards for acute renal failure (acute kidney injury) from the Acute Kidney Outcomes Initiative and the NKF state that the change in creatinine of your patient meets the criteria for this condition.

The code for renal insufficiency translates to low severity with no implication of risk to the patient, whereas CKD stages and Acute Renal Failure codes carry specific significant mortality risk. Which is your patient? “

Editor's Note: Robert S. Gold, MD, CEO of DCBA, Inc., in Atlanta, Georgia, provided the above information.

A:  I would include the patient’s lab values/treatments in the query, and state the following:

"I noted your documentation of "acute on chronic renal insufficiency secondary to dehydration", the patient's renal studies showing (insert BUN, creatinine, GFR values since admission, or attach printout of labs, and say "see attached") and treatment with (insert treatment for this condition) which show that a more specific diagnosis may be appropriate for this patient, according to RIFLE criteria.

In your next progress notes and discharge summary, please further specify this condition as one of the following:

- acute renal failure secondary to dehydration (resolved/unresolved)
- acute on chronic renal failure secondary to dehydration (resolved/unresolved)
- other
- unable to determine”

Editor's Note: Lynne Spryszak, RN, CCDS, CPC-A, Precyse Solutions, provided the above information.



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