ICD-10 Coding for Nephrotic Syndrome(N04.2, N04.21)
Complete ICD-10-CM coding and documentation guide for Nephrotic Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Nephrotic Syndrome
N04-N08Primary Range
Nephrotic syndrome and related conditions
This range includes all codes related to nephrotic syndrome, covering various morphologies and etiologies.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N04.2 | Nephrotic syndrome with diffuse membranous glomerulonephritis | Use when biopsy confirms diffuse membranous glomerulonephritis with nephrotic syndrome. |
|
| N04.21 | Nephrotic syndrome with primary membranous nephropathy | Use when primary membranous nephropathy is confirmed by biopsy. |
|
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 nephrotic syndrome
Essential facts and insights about Nephrotic Syndrome
Primary ICD-10-CM Codes for nephrotic syndrome
Decision Criteria
clinical Criteria
- Biopsy confirms diffuse membranous glomerulonephritis.
documentation Criteria
- Document nephrotic-range proteinuria and biopsy results.
Applicable To
- Primary membranous nephropathy
Excludes
- Secondary membranous nephropathy (N04.22)
Clinical Validation Requirements
- Biopsy confirmation of membranous glomerulonephritis
- Nephrotic-range proteinuria (≥3.5 g/day)
Code-Specific Risks
- Misclassification if biopsy results are not documented.
Coding Notes
- Ensure biopsy results are clearly documented to support the use of this code.
N04.21 - Nephrotic syndrome with primary membranous nephropathy
Use when primary membranous nephropathy is confirmed by biopsy.
Applicable To
- Primary membranous nephropathy
Excludes
- Secondary membranous nephropathy (N04.22)
Clinical Validation Requirements
- Biopsy confirmation of primary membranous nephropathy
- Nephrotic-range proteinuria (≥3.5 g/day)
Coding Notes
Ensure documentation specifies primary membranous nephropathy.
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 Nephrotic Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N04.2.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential reimbursement issues due to incorrect DRG assignment.
Mitigation Strategy
Ensure biopsy results are documented before coding., Train staff on the importance of complete documentation.
Impact
Reimbursement: Incorrect DRG assignment may affect reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Verify biopsy results and document primary or secondary etiology clearly.
Impact
Lack of biopsy documentation can lead to incorrect coding.
Mitigation Strategy
Implement a checklist to ensure biopsy results are included in patient records.
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 Nephrotic Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Nephrotic Syndrome
Use these documentation templates to ensure complete and accurate documentation for Nephrotic Syndrome. These templates include all required elements for proper coding and billing.
Nephrotic syndrome with primary membranous nephropathy
Specialty: NephrologyRequired Elements
- Biopsy results
- Proteinuria levels
- Serum albumin levels
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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