Created Aug 2020
A 56-year-old male was admitted with decompensated heart failure, started on fluid restriction and IV diuresis with frusemide infusion. Patient developed acute kidney failure secondary to IV diuretic therapy, then developed uraemic pericarditis secondary to the acute kidney failure. Patient does not have a history of chronic kidney failure.
Following the ICD-10-AM Alphabetic Index, uraemic pericarditis leads to a dagger and asterisk code combination of N18.5 Chronic kidney disease, stage 5 and I32.8 Pericarditis in other disease classified elsewhere.
As the ICD-10-AM Alphabetic Index is a dagger and asterisk code combination should the Index be followed even though the patient has no history of chronic kidney failure?
- uraemic N18.5†, I32.8*
Uraemic pericarditis typically occurs in patients with chronic kidney failure, which is supported by the ICD-10-AM Alphabetic Index with the dagger and asterisk code combination.
As there is no history or documentation of chronic kidney failure, clinical coders should seek clarification of the diagnosis ‘uraemic pericarditis’ from the clinician. Where it is not possible to clarify with the clinician, clinical coders must adhere to the classification convention ‘The Dagger and Asterisk System’ from the ICD-10-AM Alphabetic Index and Tabular List, and ACS 0001 Principal Diagnosis and assign the dagger and asterisk code combination of N18.5 Chronic kidney disease, stage 5 and I32.8 Pericarditis in other disease classified elsewhere. Free text should be used to add specificity.