Coding Tip of the Month – February 2018

Hemodialysis Duration

Three new duration values were added to code table 5A1, Physiological Systems, Performance, to capture the duration and continuity of hemodialysis procedures:

  • 7 Intermittent – Less than 6 hours per day
  • 8 Prolonged Intermittent – 6 – 18 hours per day
  • 9 Continuous – Greater than 18 hours per day

These new values were designed to reflect the forms of hemodialysis treatment provided to patients with acute and/or chronic renal failure categorized by duration.

The device value “7 Intermittent” should be used for Intermittent Hemodialysis which is typically prescribed for 3 – 5 hours per treatment and is performed 3 – 7 times per week. This modality is performed through a fistula or vascath, is highly efficient and used primarily for CRF.

Device value “8 Prolonged Intermittent” is applied for Prolonged Intermittent Renal Replacement Therapy (PIRRT) or Sustained Low Efficiency Dialysis (SLED) which is administered between 6 – 12 hours per day on several or all days of the week, with breaks in therapy lasting hours to days. This modality is performed through a fistula or vascath, is moderately efficient, uses traditional dialysis equipment, generally does not require anticoagulation and is used primarily for critically ill patients with ARF.

Finally, device value “9 Continuous” is applied for Continuous Renal Replacement Therapy (CRRT), also sometimes called Continuous Venovenous Hemofiltration (CVVH), Continuous Venovenous Hemodialysis (CVVHD), and Continuous Venovenous Hemodiafiltration (CVVHDF). This is performed for at least 18 hours, and can be up to 24 hours a day. It is the gentlest and slowest form of hemodialysis and is used for patients who acute kidney injury has resulted in hemodynamic instability. This modality uses a vas cath only, requires anticoagulation, is the least efficient, most costly method and is used for immobile critically ill patients with ARF.

These new ICD-10-PCS codes allow specific capture of the duration of dialysis procedures which will assist in evaluating the efficacy of hemodialysis treatment modalities.

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