What ICD-10 diagnosis code can be used for a patient with a history of acute kidney failure (AKF) who has since stopped dialysis and is being managed with Renvela (sevelamer) and Losartan (losartan) for chronic kidney disease (CKD) and hypertension?

ICD-10 Coding for a Patient with History of Acute Kidney Failure Now Recovered

The most appropriate ICD-10 code for this patient is N17.9 (Acute kidney failure, unspecified) with Z87.442 (Personal history of urinary system disorder). 1

Understanding the Patient's Kidney Condition

This patient experienced acute kidney failure in May that required dialysis during hospitalization but has since discontinued dialysis. The patient continues to follow up with nephrology and is currently on:

• Renvela (sevelamer): A phosphate binder used to control serum phosphorus in patients with chronic kidney disease 2
• Losartan: An angiotensin receptor blocker used for hypertension and kidney protection 3

Appropriate Coding Strategy

1. Primary code for the acute event:

   • N17.9 (Acute kidney failure, unspecified)
   • This is appropriate since the patient had documented acute kidney failure requiring dialysis 1

2. Secondary code for history:

   • Z87.442 (Personal history of urinary system disorder)
   • This code captures the fact that the patient has a history of kidney disease but is no longer on dialysis 1

3. Additional code if chronic kidney disease is present:

   • If recent labs were available showing reduced GFR, a code from the N18 category (Chronic kidney disease) would be appropriate
   • The specific N18.x code would depend on the stage of CKD based on GFR values 1

Clinical Reasoning

The patient's current medication regimen suggests ongoing kidney issues:

• Renvela (sevelamer): FDA-approved for control of serum phosphorus in patients with CKD on dialysis 2, though it's sometimes used off-label in non-dialysis CKD patients with hyperphosphatemia
• Losartan: Indicated for hypertension and diabetic nephropathy 3, suggesting ongoing kidney protection is needed

Without recent labs, it's not possible to definitively code for chronic kidney disease or its stage. However, the medication regimen strongly suggests the patient has some degree of residual kidney dysfunction following the acute kidney failure episode.

Important Considerations

• Follow-up with nephrology: Suggests ongoing monitoring of kidney function is necessary
• Discontinued dialysis: Indicates recovery from the acute kidney failure event
• Current medications: Suggest management of complications related to kidney disease

Common Coding Pitfalls to Avoid

1. Using N18.6 (End-stage renal disease): This would be incorrect as the patient is no longer on dialysis
2. Using only Z99.2 (Dependence on renal dialysis): Inappropriate since dialysis has been discontinued
3. Using only a history code without the acute event code: Would not fully capture the recent acute kidney failure
4. Using N19 (Unspecified kidney failure): Too vague when the type of kidney failure (acute) is known

When recent laboratory values become available, consider updating the diagnosis coding to include the appropriate N18.x code for chronic kidney disease if GFR remains reduced, as the KDIGO guidelines recommend classification based on both GFR and albuminuria for proper CKD staging 1.