From the Guidelines
The primary ICD-10 diagnoses for a patient with End-Stage Renal Disease who has missed dialysis for two weeks and is fluid overloaded should include N18.6 (End-Stage Renal Disease), E87.70 (Fluid Overload), and Z91.15 (Patient's Noncompliance with Renal Dialysis). Additional relevant codes might include I50.9 (Heart Failure, unspecified) if the fluid overload has led to heart failure symptoms, E87.5 (Hyperkalemia) if the patient has elevated potassium levels, and E87.2 (Acidosis) if metabolic acidosis is present 1. This patient requires immediate dialysis to address the fluid overload and electrolyte abnormalities. The missed treatments have likely resulted in accumulation of uremic toxins, potassium, and fluid that can lead to life-threatening complications including pulmonary edema, cardiac arrhythmias, and uremic encephalopathy. Management should include urgent hemodialysis, possibly with ultrafiltration to remove excess fluid, careful monitoring of electrolytes (especially potassium), and addressing the underlying reasons for missed dialysis sessions to prevent recurrence.
Some key considerations in the management of this patient include:
- The use of intravenous loop diuretics to reduce fluid overload, as recommended by the 2013 ACCF/AHA guideline for the management of heart failure 1
- The potential need for additional diuretics, such as thiazides, to enhance diuretic responsiveness 1
- The importance of careful monitoring of electrolytes, renal function, and volume status to guide therapy 1
- The consideration of ultrafiltration to remove excess fluid, particularly if the patient is resistant to diuresis 1
Overall, the goal of management should be to rapidly alleviate the patient's fluid overload and electrolyte abnormalities, while also addressing the underlying causes of the missed dialysis sessions to prevent recurrence. The most recent and highest quality study, the 2013 ACCF/AHA guideline for the management of heart failure 1, provides the best guidance for the management of this patient.
From the FDA Drug Label
The provided drug label does not contain information about ICD-10 diagnoses.
The FDA drug label does not answer the question.
From the Research
ICD-10 Diagnoses for ESRD and Fluid Overload
The primary ICD-10 diagnoses for a patient with End-Stage Renal Disease (ESRD) who has missed dialysis for two weeks and is fluid overloaded include:
- ESRD: N18.6 (End-stage renal disease)
- Fluid overload: E87.7 (Fluid overload)
- Missed dialysis sessions may also be coded as Z99.2 (Dependence on dialysis) or Z99.1 (Dependence on renal dialysis), however these codes may not be directly relevant to the current admission.
Additional Diagnoses to Consider
Other diagnoses that may be relevant to the patient's condition include:
- Hypertension: I10 (Essential hypertension) or I11 (Hypertensive heart disease)
- Volume depletion or electrolyte imbalances: E87.1 (Hypovolemia) or E87.4 (Electrolyte imbalance)
- Any underlying conditions that contributed to the development of ESRD, such as diabetes mellitus (E11) or hypertension (I10)
Coding Guidance
When coding for ESRD and fluid overload, it is essential to follow the official ICD-10 coding guidelines 2. The codes listed above are based on the information provided and may not be exhaustive. A thorough review of the patient's medical record and consultation with a certified coder or healthcare professional may be necessary to ensure accurate coding.
Clinical Relevance
The management of fluid overload in patients with ESRD is crucial to prevent complications such as hypertension, heart failure, and mortality 3. The use of diuretics, such as metolazone and furosemide, may be effective in managing fluid overload in these patients 4. Additionally, aggressive fluid resuscitation may be safe in ESRD patients with severe sepsis or septic shock 5.