Step 1. Check if the case’s procedure text contains ‘Kidney’ OR 'Renal' AND ‘transplant’ OR ‘txp’. If yes, proceed to step 2. If no, return ‘No.’

Step 2. Check if the case’s Diagnosis text contains the below text. If present, return ‘No.’ If not present, proceed to step 3.

• “Renal Donor”
• “Kidney Donor”
• “Other complication of kidney transplant”

Step 3. Check if the case’s Diagnosis text OR procedure text contains the below text. If present, proceed to step 7a.  If not present, proceed to step 4.

• “Kidney transplant recipient”
• “Kidney transplant candidate”
• “Renal transplant recipient”

Step 4. Check if the case has at least ONE of the below Surgical CPT Codes listed as the case Primary Surgical CPT. If the case does have one of the codes listed below, proceed to step 7a. If the case does not have a primary surgical CPT listed, proceed to step 5.

• • 50360 - Renal allotransplantation, implantation of graft; without recipient nephrectomy
  • 50365 - Renal allotransplantation, implantation of graft; with recipient nephrectomy
  • 50380 - Renal autotransplantation, reimplantation of kidney
• Note:
  • The AIMS start date for the CPT codes must match the procedure date.

Step 5. Check the case for of the following Anesthesia CPT code. If yes, proceed to step 7a. If no, proceed to step 6.

• Anesthesia CPT Codes:
  • 00868- Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal transplant (recipient)
  • Note:
    • Only consider predicted CPTs if the actual CPT is missing. 

Step 6. Check the case has an ASA >=3.  If yes, proceed to step 7a. If no, return ‘No.’

Step 7a. Check the case for the following procedure text. If present, return ‘No.’  If not present, proceed to step 7b.

• *Biopsy, bring, colon, excision, exchange, Explor, hematoma, reimplant, remov, replace, repair, revision, , wound, re-explor, transplanted

*Do not exclude if the text ‘with’ is prior to biopsy

Step 7b. Check the case for the following Diagnosis text. If present, return ‘No.’  If not present, proceed to step 8.

• “Failed kidney transplant”
• “Kidney transplant failure”
• “Reject”
• “Graft failure”
• “Retransplant”
• “Post kidney transplant”
• “pre-transplant”
• “evaluation”

Step 8. Check that the case has at least ONE of the following Surgical Service Concept IDs. If yes proceed to step 9. If no, return no.

• 0 - Unknown Concept
• 80000 - Surgical Service - Not Specified
• 80001 - Surgical Service - other
• 80002 - Vascular
• 80005 - Cardiac
• 80006 - General
• 80014 - Surgical service - other, not listed
• 80017 - Medical - gastroenterology
• 80023 – Urology
• 80024 - Medical - hematology/oncology
• 80027 – Transplant
• 80032 – Pediatric General Surgery
• 80040 – Pediatric Surgery
• 80088 - Cardiothoracic
• 80118 - Cardiothoracic-Vascular

Step 9. Check if the case is ASA Class 1, 6 or 6E. If yes, return no.  If no, proceed to step 10.

Step 10. Check cases that have diagnosis code Z52.4.  If present, follow the checks below.  If not present, return ‘Yes.’

• If the case has any of the following return ‘Yes.’ If no, return, ‘No.’
  • CPT codes 50360, 50365, or 50380, return Yes.
  • Diagnosis codes that contain the following N18%, N19%