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v1.0.0
ICD-10 Guide
DiagnosesAcute Renal Failure Trial Network Study

Acute Renal Failure Trial Network Study

ICD-10 Coding for Acute Tubular Necrosis(N17.0, T86.12)

PRIMARY SPECIALTYNephrology
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Acute Renal Failure Trial Network Study?
Essential facts and insights about Acute Tubular Necrosis

Key Clinical Considerations:

  • Acute onset of renal impairment, often indicated by a sudden increase in serum creatinine levels or a decrease in urine output.
  • Laboratory findings may include elevated serum creatinine, elevated blood urea nitrogen (BUN), and electrolyte imbalances such as hyperkalemia.
  • Physical examination may reveal signs of fluid overload, such as edema, hypertension, or altered mental status.
  • Imaging studies like ultrasound may show renal enlargement or obstruction, while CT scans can help identify underlying causes.
  • Severity criteria include staging based on serum creatinine levels and urine output, as per the KDIGO guidelines.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Medical records must document the acute nature of renal failure, including onset and duration of symptoms.
  • Specific terminology such as 'acute tubular necrosis' or 'ATN' must be used to ensure clarity in diagnosis.
  • Examples include documenting the patient's renal function tests, fluid intake/output records, and any interventions performed.
  • Medical necessity must be established through documentation of symptoms, diagnostic tests, and treatment plans.
  • Quality measures may require documentation of follow-up care and monitoring of renal function post-diagnosis.

Coding Guidelines

Usage Guidelines & Examples

  • Use N17.0 for acute tubular necrosis due to ischemia or nephrotoxins; use T86.12 for acute renal failure due to complications of a transplant.
  • Do not use N17.0 for chronic renal failure or acute kidney injury due to pre-existing chronic conditions.
  • Compare with N17.9 (acute kidney failure, unspecified) for cases where the specific cause is not identified.
  • Common errors include misclassifying acute renal failure as chronic; ensure documentation supports the acute diagnosis.
  • In complex cases, consider the underlying cause of renal failure and document accordingly to select the appropriate code.

Code Exclusions

Important Exclusions

  • Exclude chronic kidney disease (N18) as it represents a different pathophysiological process.
  • Alternative codes for excluded conditions include N17.9 for unspecified acute kidney failure.
  • Conditions are excluded based on the duration and nature of renal impairment; chronic conditions do not qualify.
  • Common mistakes include coding acute renal failure when chronic conditions are documented; ensure clarity in documentation.
  • Related but distinct conditions include acute interstitial nephritis and acute glomerulonephritis, which have different coding.

Related ICD-10 Codes

Primary Codes
N17.0
Acute tubular necrosis
T86.12
Acute renal failure due to complications of kidney transplant
Ancillary Codes
R34
N17.0
.
Differential Codes
N17.9
N17.9
only when specific type of necrosis is not documented.

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Nephrology

Specialty Applications

  • Applies to patients with acute kidney injury, particularly those with risk factors such as dehydration, sepsis, or nephrotoxin exposure.
  • Patient populations include adults and children, with increased risk in the elderly and those with comorbidities.
  • Clinical settings include inpatient hospital admissions, outpatient nephrology clinics, and emergency departments.
  • Specialty-specific applications are relevant in nephrology, critical care, and emergency medicine.
  • Treatment contexts include initiation of dialysis, fluid management, and addressing underlying causes.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with acute tubular necrosis based on elevated serum creatinine and decreased urine output.'

Template 2

Template: 'Clinical presentation consistent with acute renal failure including oliguria and fluid overload.'

Template 3

Template: 'Diagnostic criteria for acute tubular necrosis met as evidenced by renal function tests and imaging studies.'

Template 4

Template: 'Treatment plan initiated for acute renal failure with fluid management and nephrology consultation.'

Template 5

Template: 'Follow-up care for acute tubular necrosis including monitoring of renal function and electrolyte levels.'

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Documentation must include clinical findings, lab results, and treatment plans.

How does this differ from similar diagnoses?

Acute tubular necrosis is characterized by specific causes like ischemia or nephrotoxins, unlike chronic conditions.

What are common billing considerations?

Ensure accurate coding to reflect the acute nature of the condition for appropriate reimbursement.

What procedures are typically associated?

Related CPT codes may include dialysis procedures and renal function tests.

Are there any quality reporting implications?

Quality measures may include monitoring renal function and documenting follow-up care.