ICD-10 Coding for Pyelonephritis(N10, N13.6, T86.13)
Complete ICD-10-CM coding and documentation guide for Pyelonephritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pyelonephritis
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N10 | Acute pyelonephritis | Use for acute kidney infections without obstruction or transplant involvement. |
|
| N13.6 | Pyonephrosis | Use when pyelonephritis is complicated by obstruction and infection. |
|
| T86.13 | Kidney transplant infection | Use for infections specifically involving a transplanted kidney. |
|
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 acute pyelonephritis
Essential facts and insights about Pyelonephritis
Primary ICD-10-CM Codes for pyelonephritis
Decision Criteria
clinical Criteria
- Presence of flank pain and fever with positive urine culture
documentation Criteria
- Explicit mention of 'acute pyelonephritis' in the medical record
Applicable To
- Acute pyelonephritis due to infection
Excludes
- Chronic pyelonephritis (N11.-)
Clinical Validation Requirements
- Urine culture positive for bacteria
- Imaging showing renal parenchymal striations
Code-Specific Risks
- Confusion with cystitis if documentation is unclear
Coding Notes
- Ensure documentation specifies 'acute pyelonephritis' to avoid miscoding.
N13.6 - Pyonephrosis
Use when pyelonephritis is complicated by obstruction and infection.
Applicable To
- Infected hydronephrosis
Excludes
- Acute pyelonephritis without obstruction (N10)
Clinical Validation Requirements
- Imaging showing hydronephrosis with infection
- Presence of pus in the renal pelvis
Coding Notes
Ensure imaging confirms obstruction and infection.
T86.13 - Kidney transplant infection
Use for infections specifically involving a transplanted kidney.
Applicable To
- Infection of transplanted kidney
Clinical Validation Requirements
- Evidence of infection in a transplanted kidney
- Positive culture or imaging findings
Coding Notes
Always document the transplant status and infection site.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere
B96.20Differential 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 Pyelonephritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N10.
Impact
Clinical: May lead to inappropriate treatment focus., Regulatory: Fails to meet specificity requirements for coding., Financial: Potential for reduced reimbursement due to non-specific coding.
Mitigation Strategy
Educate clinicians on the importance of specifying infection sites., Implement EHR prompts for detailed infection documentation.
Impact
Reimbursement: Incorrect coding may lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation specifies 'pyelonephritis' to use N10.
Impact
Reimbursement: Incorrect sequencing can affect DRG assignment., Compliance: Violates sequencing rules., Data Quality: Misrepresents clinical severity.
Mitigation Strategy
Always sequence transplant complication codes before infection codes.
Impact
Failure to correctly sequence T86.13 before other infection codes.
Mitigation Strategy
Regular training on sequencing rules and audit reviews.
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 Pyelonephritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pyelonephritis
Use these documentation templates to ensure complete and accurate documentation for Pyelonephritis. These templates include all required elements for proper coding and billing.
Acute Pyelonephritis in Emergency Department
Specialty: Emergency MedicineRequired Elements
- Patient history of present illness
- Physical examination findings
- Laboratory and imaging results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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