# Help: Acute Renal Failure followin labor and delivery



## jamiemarie (Oct 27, 2009)

I had a question on a study guide for ICD-9-CM coding for my students. 

It was: *Acute renal failure following labor and delivery*, the codes on the answer key were: 
584.9 and 669.32

When reading in the book it states: 

584
Excludes
following labor and delivery (669.3)
posttraumatic (958.5)
that complicating:
abortion (634-638 with .3, 639.3)
ectopic or molar pregnancy (639.3)​Yet listed under 584.9 the only exludes are:

584.9
Excludes
traumatic kidney injury (866.00-866.13)​
When you read 669.32 it is for acute renal failure following labor and delivery:
2009 ICD-9-CM Diagnosis Code 669.32
Acute renal failure with delivery with postpartum complication

I read the guidelines and I did not see anything regarding multiple coding, and after reading the ICD-9 book on both codes 584  clearly stated to exclude 669.3  so my question is 669.32 the only code that would be used or am I miising or forgetting something and thats why you would use both 584.9 and 669.32?


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## cleanclaims (Oct 27, 2009)

There are numerous kinds of renal failure, as well as stages of renal failure, and since your description doesn't list any additional information, the unspecified code would be appropriate.  (584.9) The post partum code indicates the circumstances surrounding the renal failure, so both codes would be appropriate to give an accurate description of the patient's diagnosis.


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## jamiemarie (Oct 28, 2009)

*response to blondemoment*

Sorry I should have mentioned it was a study guide that just listed that and they had to code appropriately.

Even though it states in the beginning of code *584* that it excludes _669.3_?

I think thats where my students are seeing the 584 code excludes 669.3 and they feel that 669.32  includes all: acute renal failure following labor and delivery. 

I agree with you but even though I explained that, they read *excludes*, and at that point we did teach them that if a code _excludes_ another you never code them together, so I told them I would get further advice and follow up with them. They are having a test tonight and just want to be sure they have all the correct information.

Seeing on 584 codes exclude 669.3 how do I explain why in this case you wouldn't follow that rule for ICD-9-CM? I have to say I agreed with them as well when I coded it myself. 

Thank so much


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## Anna Weaver (Oct 28, 2009)

*acute renal failure*

I'm just going to throw this one out here, what do you think:

You would exclude 669x with 584x because your 669 codes should be primary dx. That's why you can use them together, but your 669 is primary, 584 secondary never the other way around (584x, 669x).


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## mitchellde (Oct 28, 2009)

If you will note in the book 669 catergory and 669.3 code do not require nor need a secondary code, which is why these are excluded with the 584 category.  669.3x already states the acute renal failure so to use the 584.x code in addition is redundant.  And yest the chapter 11 codes have sequencing priority and always goe first.  So did the study guide have an answer that was just the 669.32 or 669.34?  if so that is the correct answer.


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## jamiemarie (Oct 29, 2009)

*Response*

Well, according to a post I found online, it states, For Acute Renal Failure you would always code that first to specify the stage and then code the underlying disease (the cause), so sort of like the "due to" factor, so I see what blondemoment meant. According to the study guides answers it states 584.9 (first) then 669.32 (second). So I was just questioning the fact that 584, not 584.9 excluded the 669.3, and why our study guide answers (electronic format) stated to code that way.

Thanks - Jamie


Anna Weaver said:


> I'm just going to throw this one out here, what do you think:
> 
> You would exclude 669x with 584x because your 669 codes should be primary dx. That's why you can use them together, but your 669 is primary, 584 secondary never the other way around (584x, 669x).


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## mitchellde (Oct 29, 2009)

That is for anyone except preganant ladies.  If you refer to the coding guidelines it will tell you that chapter 11 codes always supersede all other codes and guidelines.  584 is the category header and whatever is excluded by the catergory goes for every code in that catergory.  for your scenario it is the 669.3x code only.

From the guidelines:
a.
General Rules for Obstetric Cases
1)
Codes from chapter 11 and sequencing priority
Obstetric cases require codes from chapter 11, codes in the range 630-679, Complications of Pregnancy, Childbirth, and the Puerperium. Chapter 11 codes have sequencing priority over codes from other chapters.


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## jamiemarie (Oct 29, 2009)

*Response*

I agree, yet the study guide had the 584.9 (first) and the 669.3 (second). I also noticed that the ICD-9-CM 669.3 was a revised text, so maybe at one point it wasn't like that and the system hasn't updated the answers yet . 
Funny I agree with the fact that 669.32 should be sequenced due to Chapter 11 guidelines, yet I found an article on Acute Renal Failure that stated the 584 codes would be coded first and then underlying cause would be coded second and the study guide had it listed ion that oorder, with note by it for the answer key "list in that order only", confusing huh. 

I personally feel that 669.32 states enough for correct coding for the question asked. I just wanted to be sure that there were not specific guidelines for renal failure and the obstetric codes that I didn't know about. 

Thanks for the help! 




mitchellde said:


> If you will note in the book 669 catergory and 669.3 code do not require nor need a secondary code, which is why these are excluded with the 584 category.  669.3x already states the acute renal failure so to use the 584.x code in addition is redundant.  And yest the chapter 11 codes have sequencing priority and always goe first.  So did the study guide have an answer that was just the 669.32 or 669.34?  if so that is the correct answer.


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## mitchellde (Oct 29, 2009)

I am certain the artice you are referenceing was not talking about renal failure due to pregnancy.  If you follow the logic of code the underlying condition first then that would be the pregnancy since it was what caused the renal failure.  and you code only the 669.xx code as the 584 category excludes the use of the 669.xx code.  I would say you need to contact the vendor of the study guide as the answer can be proven incorrect.  this really is not new, it has been this way for a really long time.


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## Anna Weaver (Oct 29, 2009)

*following L & D*



mitchellde said:


> If you will note in the book 669 catergory and 669.3 code do not require nor need a secondary code, which is why these are excluded with the 584 category.  669.3x already states the acute renal failure so to use the 584.x code in addition is redundant.  And yest the chapter 11 codes have sequencing priority and always goe first.  So did the study guide have an answer that was just the 669.32 or 669.34?  if so that is the correct answer.



Well, DuH!!! I should have caught that. Thanks for pointing me in the right direction. Yes, the 584 is not needed with the 669.3x as it states it all right there in the description.


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## jamiemarie (Oct 29, 2009)

*Response*

Yes I agree, 669.32 should be the only code, it clearly states it all, I agree in the beginning, but you would think the study guides would be correct so it makes you question yourself whether you know your right or not. This has been an on-going issue with these study guides from what I have been told. I have found a few errors myself and have had to change them on the instructor key. I am in the process of having these reviewed. 

Thanks for the help.





mitchellde said:


> I am certain the artice you are referenceing was not talking about renal failure due to pregnancy.  If you follow the logic of code the underlying condition first then that would be the pregnancy since it was what caused the renal failure.  and you code only the 669.xx code as the 584 category excludes the use of the 669.xx code.  I would say you need to contact the vendor of the study guide as the answer can be proven incorrect.  this really is not new, it has been this way for a really long time.


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## BarbSlattery (Nov 2, 2009)

I think that the 669.32 would cover it. It doesnt say to add addtional code to identify the condition further.  I


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