We have a question regarding advice published in the Coding Clinic, Second Quarter 2003, page 7. The question is regarding acute renal failure secondary to the lupus nephritis which was assigned code 584.9 for the acute renal failure. Consultants have advised that 584.8 should be used instead of 584.9. Coders are not sure about the correct code assignment. Wouldn't code 584.8, Acute renal failure with other specified pathological lesion, be more appropriate given that the physician explicitly linked the acute renal failure to lupus nephritis?
No, the correct code is 584.9, Acute kidney failure, unspecified. The ICD-9-CM Coordination and Maintenance Committee recently entertained proposals to revise the codes in category 584, Acute renal failure. The Coding Clinic Editorial Advisory Board and the Cooperating Parties have also had multiple extensive discussions with clinical subject matter experts regarding these codes.
Unfortunately, there is a lack of clinical consensus on these conditions or how category 584 should be restructured. In light of the current ICD-9-CM structure, the partial code-set freeze in effect, and the limited remaining years for ICD-9-CM, the advice published in Coding Clinic, Second Quarter 2003, still stands.