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ICD-10 Coding for Stage 4 Kidney Disease(N18.4, I12.9)

Complete ICD-10-CM coding and documentation guide for Stage 4 Kidney Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Chronic Kidney Disease Stage 4CKD Stage 4

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Related ICD-10 Code Ranges

Complete code families applicable to Stage 4 Kidney Disease

N18.1-N18.9Primary Range

Chronic kidney disease (CKD) stages 1-5 and end stage renal disease (ESRD)

This range includes all stages of chronic kidney disease, with N18.4 specifically representing stage 4.

I12-I13

Hypertensive chronic kidney disease

Used when CKD is due to hypertension, requiring linkage documentation.

E08-E13

Diabetes mellitus

Used when CKD is due to diabetes, requiring linkage documentation.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
N18.4Chronic kidney disease, stage 4 (severe)Use when the patient has CKD stage 4 with GFR between 15-29 mL/min/1.73m² and not on dialysis.
  • GFR 15-29 mL/min/1.73m² on ≥2 tests 90 days apart
  • Documentation of CKD stage 4
I12.9Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney diseaseUse when CKD stage 4 is due to hypertension.
  • Documentation of hypertension and CKD stage 4

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 stage 4 kidney disease

Essential facts and insights about Stage 4 Kidney Disease

The ICD-10 code for stage 4 kidney disease is N18.4, representing severe CKD with a GFR of 15-29 mL/min/1.73m².

Primary ICD-10-CM Codes for stage 4 kidney disease

N18.4
Chronic kidney disease, stage 4 (severe)
Billable Code

Decision Criteria

clinical Criteria

  • GFR between 15-29 mL/min/1.73m²

coding Criteria

  • Patient not on dialysis

Applicable To

  • CKD stage 4

Excludes

  • End stage renal disease (N18.6)

Clinical Validation Requirements

  • GFR 15-29 mL/min/1.73m² on ≥2 tests 90 days apart
  • Documentation of CKD stage 4

Code-Specific Risks

  • Incorrectly coding as ESRD if patient is on dialysis

Coding Notes

  • Ensure documentation specifies CKD stage and any causal conditions like hypertension or diabetes.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Dependence on renal dialysis

Z99.2
Use when the patient is on dialysis.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

End stage renal disease

N18.6
Use N18.6 if the patient is on dialysis.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Stage 4 Kidney Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N18.4.

Impact

Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.

Mitigation Strategy

Always document the causal relationship in the patient's record., Use specific language linking CKD to hypertension.

Impact

Reimbursement: Incorrect coding can lead to reimbursement issues., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient data records.

Mitigation Strategy

Use N18.6 for ESRD if the patient is on dialysis.

Impact

Lack of GFR documentation can lead to audit issues.

Mitigation Strategy

Ensure GFR is documented in all CKD-related notes.

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 Stage 4 Kidney Disease, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Stage 4 Kidney Disease

Use these documentation templates to ensure complete and accurate documentation for Stage 4 Kidney Disease. These templates include all required elements for proper coding and billing.

Nephrology Progress Note

Specialty: Nephrology

Required Elements

  • Patient symptoms
  • GFR values
  • Causal conditions
  • Treatment plan

Example Documentation

[**Subjective**] Pt reports fatigue, +2 pedal edema. Adherent to renal diet. [**Objective**] BP 158/94, eGFR 19 (MDRD), K+ 5.2, uACR 320 mg/g [**Assessment**] 1. Hypertensive CKD stage 4 (I12.9, N18.4) 2. Hyperkalemia (E87.5) [**Plan**] - Start sodium zirconium cyclosilicate - Nephrology follow-up q2mo

Examples: Poor vs. Good Documentation

Poor Documentation Example
Renal failure
Good Documentation Example
Hypertensive CKD stage 4, eGFR 18, proteinuria 300 mg/g
Explanation
The good example specifies the CKD stage, GFR, and causal condition, providing a complete clinical picture.

Need help with ICD-10 coding for Stage 4 Kidney Disease? Ask your questions below.

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