ICD-10 Coding for End-Stage Kidney Disease(N18.6, I12.0)
Complete ICD-10-CM coding and documentation guide for End-Stage Kidney Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to End-Stage Kidney Disease
N18.5-N18.6Primary Range
Chronic kidney disease, stage 5 and end-stage renal disease
This range includes the codes for the most severe stages of chronic kidney disease, specifically stage 5 and end-stage renal disease, which require dialysis or transplant.
Hypertensive chronic kidney disease
These codes are used when hypertension is a contributing factor to the kidney disease, often requiring combination coding with N18 codes.
Type 2 diabetes mellitus with diabetic chronic kidney disease
This code is used when diabetes is a contributing factor to the kidney disease, requiring combination coding with N18 codes.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N18.6 | End-stage renal disease | Use when the patient is on dialysis or has a kidney transplant due to end-stage renal disease. |
|
| I12.0 | Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end-stage renal disease | Use when hypertension is a contributing factor to ESRD. |
|
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: ICD-10 code for end-stage kidney disease
Essential facts and insights about End-Stage Kidney Disease
Primary ICD-10-CM Codes for end-stage kidney disease
Decision Criteria
clinical Criteria
- Patient is on dialysis or has a kidney transplant.
documentation Criteria
- Documentation must specify ESRD and treatment status.
Applicable To
- ESRD requiring dialysis
- ESRD post-transplant
Excludes
- Acute kidney failure (N17.-)
Clinical Validation Requirements
- GFR <15
- Dialysis dependence
- Transplant status
Code-Specific Risks
- Incorrectly coding ESRD without dialysis or transplant status
Coding Notes
- Ensure documentation explicitly states 'end-stage renal disease' and includes dialysis or transplant status.
I12.0 - Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end-stage renal disease
Use when hypertension is a contributing factor to ESRD.
Applicable To
- Hypertension with ESRD
Excludes
- Hypertensive heart and chronic kidney disease (I13.-)
Clinical Validation Requirements
- Hypertension diagnosis
- Linkage to ESRD
Coding Notes
Ensure hypertension is documented as contributing to kidney disease.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting End-Stage Kidney Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N18.6.
Impact
Clinical: Leads to inadequate treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always document and code the specific CKD stage.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Verify and document dialysis or transplant status before coding ESRD.
Impact
Coding ESRD without proper documentation of dialysis or transplant.
Mitigation Strategy
Implement regular documentation audits.
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 End-Stage Kidney Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for End-Stage Kidney Disease
Use these documentation templates to ensure complete and accurate documentation for End-Stage Kidney Disease. These templates include all required elements for proper coding and billing.
ESRD patient on dialysis
Specialty: NephrologyRequired Elements
- GFR value
- Dialysis type and schedule
- Etiology of ESRD
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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