Find comprehensive information on hemodialysis, including clinical documentation requirements, medical coding guidelines for ICD-10 codes (N18.5, N18.6) and CPT codes (90935, 90937, 90940), vascular access management, and best practices for healthcare professionals. Learn about dialysis treatment, end-stage renal disease (ESRD) management, and related complications for accurate coding and optimal patient care. This resource covers key aspects of hemodialysis for physicians, nurses, and medical coders seeking accurate and up-to-date information.
Also known as
Dependence on renal dialysis
Patient requires regular dialysis for kidney failure.
Chronic kidney disease stage 5
Advanced kidney disease requiring dialysis or transplant.
Hypertensive chronic kidney disease with stage 5 chronic kidney disease
Kidney failure due to high blood pressure, requiring dialysis/transplant.
Hypertensive heart and chronic kidney disease with stage 5 chronic kidney disease
Heart and kidney failure from high blood pressure needing dialysis/transplant.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the hemodialysis for chronic kidney disease?
Yes
Is there stage 5 chronic kidney disease?
No
Is it for acute kidney injury?
When to use each related code
| Description |
|---|
| Hemodialysis |
| Peritoneal dialysis |
| Chronic kidney disease stage 5 |
Inaccurate coding of complications related to AV fistula or graft, such as stenosis or infection, impacting reimbursement and quality metrics.
Insufficient documentation of hemodialysis session time, leading to undercoding or overcoding and potential compliance issues.
Incomplete capture of comorbidities like hypertension or diabetes impacting accurate case-mix adjustment and appropriate reimbursement.
Q: What are the most effective strategies for managing intradialytic hypotension in patients undergoing hemodialysis, considering both immediate and long-term interventions?
A: Intradialytic hypotension (IDH) is a frequent complication in hemodialysis, impacting patient outcomes and quality of life. Effective management requires a multi-faceted approach. Immediate interventions include reducing ultrafiltration rate, administering saline boluses, and adjusting dialysate temperature. Long-term strategies involve optimizing dry weight, managing interdialytic weight gain, and addressing underlying contributing factors such as autonomic dysfunction or medications. Explore how individualized sodium profiling and bioimpedance spectroscopy can contribute to optimized fluid management and reduce IDH incidence. Consider implementing protocols for proactive identification and management of IDH based on patient-specific risk factors. Learn more about the role of midodrine and other pharmacological interventions in refractory cases.
Q: How can I differentiate between different types of access-related complications in hemodialysis patients (e.g., stenosis, thrombosis, infection) and determine the most appropriate intervention for each?
A: Differentiating between access-related complications requires careful clinical evaluation and appropriate diagnostic testing. Stenosis often presents with decreased thrill or bruit, prolonged bleeding time, and increased venous pressure during dialysis. Doppler ultrasound is the gold standard for diagnosis. Thrombosis may manifest as sudden loss of access function, pain, and swelling. Treatment often involves thrombolysis or surgical thrombectomy. Infection, indicated by redness, warmth, pain, and fever, often requires antibiotic therapy and potential surgical intervention. Consider implementing routine access surveillance protocols to detect early signs of complications. Explore how the use of standardized diagnostic algorithms can ensure prompt and appropriate intervention for each specific access issue. Learn more about the latest guidelines for infection prevention and control in hemodialysis settings.
Patient presents for scheduled hemodialysis treatment due to end-stage renal disease (ESRD). The patient reports feeling generally well today, with no new complaints of fatigue, shortness of breath, edema, or chest pain. Vital signs stable and within normal limits. Pre-dialysis weight of [weight] kg, blood pressure of [blood pressure], and heart rate of [heart rate]. Access site (arteriovenous fistula or arteriovenous graft) examined and found to be patent, without signs of infection or thrombosis. Hemodialysis treatment initiated with [dialyzer type] dialyzer and [dialysate prescription], targeting a prescribed fluid removal of [fluid removal amount]. Treatment duration [duration] hours. Intra-dialytic vitals monitored continuously and remained stable. Post-dialysis weight of [weight] kg achieved. Patient tolerated the treatment well without any adverse events such as hypotension, muscle cramps, or nausea. Post-dialysis blood pressure of [blood pressure] and heart rate of [heart rate]. Access site remains patent and without complications. Patient discharged in stable condition with instructions to follow prescribed renal diet, fluid restrictions, and medication regimen. Follow-up appointment scheduled for [date]. ICD-10 code N99.2 (Maintenance dialysis) and CPT code 90935 (Hemodialysis procedure) are appropriate for this encounter. Documentation supports medical necessity for ongoing hemodialysis treatment due to chronic kidney disease stage 5.