ICD-10 Coding for History of Pyelonephritis(N11.0, N11.1, Z87.440)
Complete ICD-10-CM coding and documentation guide for History of Pyelonephritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to History of 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 |
|---|---|---|---|
| N11.0 | Chronic pyelonephritis obstructive/reflux-associated | Use when there is documented chronic pyelonephritis with evidence of obstruction or reflux. |
|
| N11.1 | Chronic pyelonephritis due to underlying condition | Use when chronic pyelonephritis is secondary to another condition. |
|
| Z87.440 | Personal history of urinary (tract) infections | Use when documenting a past history of pyelonephritis that is no longer active. |
|
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 history of pyelonephritis
Essential facts and insights about History of Pyelonephritis
Primary ICD-10-CM Codes for history of pyelonephritis
Decision Criteria
clinical Criteria
- Presence of recurrent infections and imaging evidence of renal changes.
Applicable To
- Chronic pyelonephritis due to obstruction
- Reflux nephropathy
Clinical Validation Requirements
- Documented recurrent UTIs
- Imaging showing renal scarring or obstruction
Code-Specific Risks
- Misclassification as acute pyelonephritis
- Failure to document chronicity
Coding Notes
- Ensure chronicity and structural abnormalities are well-documented.
N11.1 - Chronic pyelonephritis due to underlying condition
Use when chronic pyelonephritis is secondary to another condition.
Applicable To
- Chronic pyelonephritis due to diabetes
- Chronic pyelonephritis in transplant patients
Excludes
- Acute pyelonephritis (N10)
- Pyonephrosis (N13.6)
Clinical Validation Requirements
- Documentation of underlying condition like diabetes or transplant
- Recurrent infections with renal changes
Coding Notes
Ensure linkage to the underlying condition is clear.
Z87.440 - Personal history of urinary (tract) infections
Use when documenting a past history of pyelonephritis that is no longer active.
Applicable To
- History of resolved pyelonephritis
Excludes
- Current urinary tract infection
Clinical Validation Requirements
- Documentation of resolved pyelonephritis with no current treatment
Coding Notes
Ensure the condition is fully resolved before using this code.
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.
Acute pyelonephritis
N10Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting History of Pyelonephritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N11.0.
Impact
Clinical: Misrepresentation of patient's current health status., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Review patient history for active conditions, Ensure documentation reflects current status
Impact
Reimbursement: Incorrect sequencing can affect DRG assignment and reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Code sepsis first, followed by transplant infection and pyelonephritis.
Impact
Failure to sequence codes correctly in complex cases.
Mitigation Strategy
Regular training on updated coding guidelines.
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 History of Pyelonephritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of Pyelonephritis
Use these documentation templates to ensure complete and accurate documentation for History of Pyelonephritis. These templates include all required elements for proper coding and billing.
Chronic Pyelonephritis in a Diabetic Patient
Specialty: NephrologyRequired Elements
- History of recurrent UTIs
- Diabetes management
- Imaging results showing renal changes
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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