The patient is a 41-year-old female with a history of lupus complicated by lupus nephritis and CKD stage 5, which has progressed to end stage renal disease (ESRD). She is admitted for insertion of a peritoneal dialysis catheter that was placed without complications. She was discharged with plans to follow-up with a dialysis nurse as an outpatient and to start peritoneal dialysis once the site has healed. Given the circumstances of admission, which condition should be sequenced as principal diagnosis (ESRD or the lupus nephritis)? The patient is not currently on dialysis.
Sequence code N18.6, End stage renal disease, as the principal diagnosis. In this case, treatment is being directed at the ESRD. Although lupus is a contributing problem, it is not the focus of treatment. Assign code M32.14, Glomerular disease in systemic lupus erythematosus, as an additional diagnosis. Code Z99.2, Dependence on renal dialysis, is not appropriate since the patient has not yet started dialysis.