Coding complications of transplanted organs has always been a coding dilemma. With the implementation of ICD-10-CM that didn’t change. However, coders have multiple directives to help in determining what a complication of the transplant is vs. non-transplant conditions and diseases. Documentation does not typically state that a condition is a complication of the transplant, and it is up to the coder to know which conditions would be considered complications. Coders are no longer only assigning codes to terms that they read in a patient record. They also have to know the function of the organs, and the disease processes. To me, the first thing I think of is, “was the function of the transplanted organ affected?” There’s no way to list out every scenario that a coder will see, but let’s look at the most common organ transplants with complications that coders see:
Was the function of the transplanted organ affected?
- Patient with pneumonia (infectious, viral, aspiration or other) and the is status post lung transplant. If the pneumonia is in the lung that was transplanted then YES this is coded as a complication of the transplanted organ. If, however, the patient happens to have pneumonia in the native lung (maybe only one lung was transplanted) then this is not a complication of the transplant. The reason for this is that the function of the specific organ must be affected. The latest Coding Clinic for ICD-10-CM/PCS, Second Quarter 2019 does give examples of this on page 6.
- Patient presents with acute renal failure due to dehydration or other condition and is status post kidney transplant. Anytime a patient has acute renal failure, the function of the transplanted kidney is affected. This can also be found in the latest Coding Clinic as cited above.
- Patient is status post liver transplant years ago and blood work showed elevated LFT’s, and the biopsy showed hepatitis. Any transplanted liver complication/disease is coded to a complication of the transplanted organ. Remember, status codes are only used when there is no disease or complication of the organs.
- Patient presents with shortness of breath and is diagnosed with acute diastolic heart failure. The patient had a heart transplant about two years ago. Even though the heart failure developed long after the transplant of the heart, this is coded as a complication of the transplant. This disease/illness affected the function of the transplanted heart. There are no timeframe restriction on complications of a transplanted organ.
- Patient presents with sepsis due to pyelonephritis and is also s/p bilateral lung transplant just a few months earlier. This would NOT be considered a complication of the lung transplant since the infection is in the urinary system. This condition may complicate the treatment given for the lung transplant, but if there is no affect in the function of the transplanted lung it is not coded as a complication.
- Patient presents status post left kidney transplant. There is still documented chronic kidney disease (CKD) due to the patient only having one functioning kidney. This would NOT be coded as a complication of the transplanted kidney unless the physician states that there is a complication of the transplant. Query may be needed on these if the documentation is unclear. If the patient has progressed to end-stage renal disease requiring dialysis again, this would be coded as a complication since the function of the transplanted kidney is affected (the need for dialysis).
Here are a few tips on coding transplant complications:
- A transplant complication is only coded if the function of the transplanted organ is affected
- Patients may still have some form of CKD even after transplant
- Malignancy of a transplanted organ should be coded as a transplant complication followed by the code C80.2, Malignant neoplasm associated with transplanted organ. An additional code for the specific malignancy should also be reported.
- Coronary atherosclerosis of a transplanted heart is not coded as a transplant complication
- Pneumonia that is specified to be of the transplanted lung is a complication since this affects the function of the lung
- Patients that present with acute kidney failure and also have a kidney transplant would be coded as a complication since the function of the kidney is affected
- Congestive heart failure in a patient that is status post heart transplant is coded as a complication of the transplanted organ
- Hepatitis in a patient that is status post liver transplant is coded as a complication of the transplanted organ
- An injury that is not related to the transplant (such as fracture of femur) would not be coded as a transplant complication
- There are no timeframe restrictions on when a complication may occur
If documentation is not clear, a query may be needed to clarify if the transplanted organ function is affected, especially when there are bilateral organs and only one is transplanted. As you can see in the references listed below, both ICD-9-CM and ICD-10-CM are very similar in advice regarding the coding of transplant complications, with the only differences really being the actual codes reported. The logic didn’t change.
Authored by Kim Boy, RHIT, CDIP, CCS, CCS-P
References
ICD-10-CM Official Guidelines for Coding and Reporting 2019
Coding Clinic, Fourth Quarter 2008 Page: 82
Coding Clinic, Third Quarter 2003 Page: 17
Coding Clinic, Fourth Quarter 2003 Page 60
Coding Clinic, Third Quarter 1998 Pages: 3-9
Coding Clinic, First Quarter 1989 Pages: 5 & 10
Coding Clinic for ICD10-CM/PCS, Second Quarter 2019 Page: 6
Coding Clinic, First Quarter 2013 Page: 24
Coding Clinic, Second Quarter 1994 Page: 9
Coding Clinic, Third Quarter 1994 Page: 8
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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.