Coding Rules Current as at 18-Oct-2016 08: 31

Published 15 June 2015,
for implementation 01 July 2015.

Ref No: Q2941 | Published On: 15-Jun-2015 | Status: Current

SUBJECT: Peritonitis in a peritoneal dialysis patient

Q:

How should peritonitis in a peritoneal dialysis patient be coded when there is no documentation that the complication is due to the device?

A:

Peritonitis is a significant complication in a peritoneal dialysis (PD) patient.  The peritonitis may be PD-related or secondary (enteric). PD-related peritonitis is due to touch contamination with pathogenic skin bacteria or to catheter-related infection. Secondary peritonitis is caused by underlying pathology of the gastrointestinal tract. Conditions that may lead to secondary peritonitis include cholecystitis, appendicitis, ruptured diverticulum, treatment of severe constipation, perforation during endoscopy, bowel ischaemia, and incarcerated hernia. Secondary peritonitis is less common than PD-related peritonitis (Burkart, J M, 2004).  

Therefore, for peritonitis in a peritoneal dialysis patient without further specification assign T85.71 Infection and inflammatory reaction due to peritoneal dialysis catheter, following the index pathway:

Complication

- dialysis

- - catheter

- - - peritoneal

- - - - infection or inflammation T85.71

and

K65.- Peritonitis

Y84.1 Kidney dialysis

Y92.22 Place of occurrence, health service area

Where another cause of the peritonitis is specified, such as perforated diverticulum, assign codes following the guidelines in ACS 0001 Principal diagnosis, Problems and Underlying Conditions and ACS 0002 Additional diagnoses.

Do not assign K91.8 Other postprocedural disorders of digestive tract, not elsewhere classified following the index entry Peritonitis/postprocedural as it is a less specific code.

Improvements to ICD-10-AM will be considered for a future edition to ensure that the index pathway supports the guidelines in ACS 1904 Procedural complications.

References:

Burkart, J M. (2004). Clinical manifestations and diagnosis of peritonitis in peritoneal dialysis.

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