Wiki ARF D/T Dehydration In A Cancer Patient that also has HTN. How to code?

[LLBS29XX]

Good morning! I have a patient that has been in and out of the hospital for colon cancer, now on feeding tube and is near then end but refuses hospice. She keeps going into the hospital with "Acute renal failure due to dehydration-resolving upon d/c". This is a home health patient. I coded as N18.9 because it was due to dehydration due to cancer. (The hospital d/c codes do not have it coded as HTN CKD). The nurse exported it with HTN CKD and N18.9. I know there is a causal assumption between the two but the discharging MD clearly states d/t to dehydration. The nurses and the intact person who calls the insurance to pre-auth (the nurses has not even assessed the patient yet) and then change what I give them. So am I wrong in how it was coded? Thanks for any help.

 

[rhondatalley]

Good morning! I have a patient that has been in and out of the hospital for colon cancer, now on feeding tube and is near then end but refuses hospice. She keeps going into the hospital with "Acute renal failure due to dehydration-resolving upon d/c". This is a home health patient. I coded as N18.9 because it was due to dehydration due to cancer. (The hospital d/c codes do not have it coded as HTN CKD). The nurse exported it with HTN CKD and N18.9. I know there is a causal assumption between the two but the discharging MD clearly states d/t to dehydration. The nurses and the intact person who calls the insurance to pre-auth (the nurses has not even assessed the patient yet) and then change what I give them. So am I wrong in how it was coded? Thanks for any help.

You stated that the documentation is for ARF but the code you are referencing is for CKD unspecified stage. (N18.9) There is an auto link for HTN with CKD so if both are documented and the provider does not say the CKD is NOT due to HTN, then it is coded as hypertensive CKD. However, there is not an autolink for ARF (N17.9) and HTN. If both are documented and the provider does not state the the ARF is due to HTN, then HTN is coded as I10 (unless CKD is also documented).