ICD-10 Coding for Chronic Kidney Injury(N18.1, N18.4, N18.6)
Complete ICD-10-CM coding and documentation guide for Chronic Kidney Injury. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Chronic Kidney Injury
N18.1-N18.6Primary Range
Chronic kidney disease stages 1-5 and end-stage renal disease
This range covers all stages of chronic kidney disease, from mild to end-stage renal disease.
Hypertensive chronic kidney disease
These codes are used when hypertension is present with chronic kidney disease.
Type 2 diabetes mellitus with diabetic chronic kidney disease
This code is used when diabetes is a contributing factor to chronic kidney disease.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N18.1 | Chronic kidney disease, stage 1 | Use when eGFR is ≥90 and there is evidence of kidney damage. |
|
| N18.4 | Chronic kidney disease, stage 4 | Use when eGFR is between 15 and 29. |
|
| N18.6 | End-stage renal disease | Use when eGFR is <15 or patient is on dialysis. |
|
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: How to code chronic kidney disease with hypertension
Essential facts and insights about Chronic Kidney Injury
Primary ICD-10-CM Codes for chronic kidney injury
Decision Criteria
clinical Criteria
- eGFR ≥90 with proteinuria
Applicable To
- GFR ≥90 with evidence of kidney damage
Excludes
- Acute kidney failure (N17.-)
Clinical Validation Requirements
- eGFR ≥90
- Proteinuria or other markers of kidney damage
Code-Specific Risks
- Misclassification if proteinuria is not documented
Coding Notes
- Ensure documentation of kidney damage markers.
N18.4 - Chronic kidney disease, stage 4
Use when eGFR is between 15 and 29.
Applicable To
- Severe reduction in kidney function
Excludes
- End-stage renal disease (N18.6)
Clinical Validation Requirements
- eGFR 15-29
Coding Notes
Ensure eGFR is documented to support stage.
N18.6 - End-stage renal disease
Use when eGFR is <15 or patient is on dialysis.
Applicable To
- Chronic kidney disease requiring dialysis
Excludes
- Acute kidney failure (N17.-)
Clinical Validation Requirements
- eGFR <15 or dialysis dependence
Coding Notes
Document dialysis status clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Dependence on renal dialysis
Z99.2Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Acute kidney failure, unspecified
N17.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Chronic Kidney Injury to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N18.1.
Impact
Clinical: May lead to incomplete treatment plans., Regulatory: Increases risk of coding audits., Financial: Potential loss of reimbursement for related conditions.
Mitigation Strategy
Always assess and document underlying conditions, Use appropriate combination codes
Impact
Reimbursement: May result in lower reimbursement rates., Compliance: Increases risk of audits., Data Quality: Leads to poor data quality and inaccurate patient records.
Mitigation Strategy
Always document and code the specific CKD stage.
Impact
Using unspecified codes when specific stages are documented.
Mitigation Strategy
Ensure eGFR and CKD stage are documented in every patient encounter.
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 Injury, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Chronic Kidney Injury
Use these documentation templates to ensure complete and accurate documentation for Chronic Kidney Injury. These templates include all required elements for proper coding and billing.
Chronic kidney disease management
Specialty: NephrologyRequired Elements
- Patient history
- eGFR values
- Etiology (e.g., diabetes, hypertension)
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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