ICD-10 Coding for Chronic Kidney Disease Stage 4(N18.4, I12.9, E11.22)
Complete ICD-10-CM coding and documentation guide for Chronic Kidney Disease Stage 4. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Chronic Kidney Disease Stage 4
N18.1-N18.9Primary Range
Chronic kidney disease stages 1-5 and unspecified
This range includes all stages of chronic kidney disease, with N18.4 specifically representing stage 4.
Hypertensive chronic kidney disease
Used when hypertension is present with CKD, affecting coding and sequencing.
Type 2 diabetes mellitus with kidney complications
Relevant when diabetes is a causal factor for CKD.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N18.4 | Chronic kidney disease, stage 4 (severe) | Use when CKD stage 4 is documented by the provider with supporting eGFR values. |
|
| I12.9 | Hypertensive chronic kidney disease with stage 1-4 CKD | Use when hypertension is documented as a contributing factor to CKD. |
|
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease | Use when diabetes is documented as a contributing factor to CKD. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: CKD stage 4 ICD-10 code
Essential facts and insights about Chronic Kidney Disease Stage 4
Primary ICD-10-CM Codes for chronic kidney disease roman numeral 4
Decision Criteria
clinical Criteria
- eGFR between 15-29 mL/min/1.73m²
documentation Criteria
- Provider documentation of CKD stage 4
Applicable To
- CKD stage 4
Excludes
- End stage renal disease (N18.6)
Clinical Validation Requirements
- eGFR between 15-29 mL/min/1.73m²
- Provider documentation of CKD stage 4
Code-Specific Risks
- Incorrectly coding as ESRD if patient is on dialysis.
Coding Notes
- Ensure CKD stage is explicitly documented by the provider.
I12.9 - Hypertensive chronic kidney disease with stage 1-4 CKD
Use when hypertension is documented as a contributing factor to CKD.
Applicable To
- Hypertension with CKD stage 1-4
Excludes
- Hypertensive heart and CKD (I13.-)
Clinical Validation Requirements
- Diagnosis of hypertension
- Documentation linking hypertension to CKD
Coding Notes
Document the causal relationship between hypertension and CKD.
E11.22 - Type 2 diabetes mellitus with diabetic chronic kidney disease
Use when diabetes is documented as a contributing factor to CKD.
Applicable To
- Diabetic nephropathy
Excludes
- Diabetes with other specified kidney complications
Clinical Validation Requirements
- Diagnosis of type 2 diabetes
- Documentation linking diabetes to CKD
Coding Notes
Ensure diabetes is documented as the cause of CKD.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Dependence on renal dialysis
Z99.2Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Chronic Kidney Disease Stage 4 to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N18.4.
Impact
Clinical: Ambiguity in clinical severity assessment., Regulatory: Non-compliance with documentation standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Educate providers on CKD staging documentation., Use templates that prompt for CKD stage.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use N18.6 if the patient is on dialysis, indicating ESRD.
Impact
Reimbursement: May affect risk adjustment and reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient's condition.
Mitigation Strategy
Ensure documentation specifies the causal relationship.
Impact
Failure to document CKD stage can lead to audit issues.
Mitigation Strategy
Ensure all CKD diagnoses include stage documentation.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Chronic Kidney Disease Stage 4, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Chronic Kidney Disease Stage 4
Use these documentation templates to ensure complete and accurate documentation for Chronic Kidney Disease Stage 4. These templates include all required elements for proper coding and billing.
Hypertensive CKD Stage 4
Specialty: NephrologyRequired Elements
- CKD stage
- Causal condition (e.g., hypertension)
- eGFR value
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Chronic Kidney Disease Stage 4? Ask your questions below.