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ICD-10 Guide
ICD-10 CodesN04.3

N04.3

Billable

Nephrotic syndrome with diffuse mesangial proliferative glomerulonephritis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/18/2025

Code Description

ICD-10 N04.3 is a billable code used to indicate a diagnosis of nephrotic syndrome with diffuse mesangial proliferative glomerulonephritis.

Key Diagnostic Point:

Nephrotic syndrome is characterized by a triad of symptoms: significant proteinuria, hypoalbuminemia, and edema. When associated with diffuse mesangial proliferative glomerulonephritis, it indicates a specific type of kidney inflammation affecting the mesangial cells. This condition often presents with heavy proteinuria, which can exceed 3.5 grams per day, leading to low serum albumin levels and resultant edema. Patients may also exhibit hematuria, hypertension, and renal insufficiency. A renal biopsy typically reveals diffuse mesangial proliferation, which is a hallmark of this condition. The etiology can be idiopathic or secondary to systemic diseases such as lupus or infections. Management often involves corticosteroids and immunosuppressive agents, alongside supportive care for edema and hypertension. Regular monitoring of renal function and proteinuria is essential for assessing treatment efficacy and disease progression.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of nephrotic syndrome and glomerulonephritis pathology.
  • Differentiation from other types of nephrotic syndrome.
  • Need for accurate documentation of renal biopsy findings.
  • Potential for overlapping symptoms with other renal conditions.

Audit Risk Factors

  • Inadequate documentation of renal biopsy results.
  • Failure to document the severity of proteinuria.
  • Misclassification of nephrotic syndrome type.
  • Lack of follow-up documentation on treatment response.

Specialty Focus

Medical Specialties

Nephrology

Documentation Requirements

Detailed clinical notes on symptoms, lab results, and treatment plans.

Common Clinical Scenarios

Patients presenting with edema, proteinuria, and renal dysfunction.

Billing Considerations

Ensure accurate recording of renal function tests and biopsy findings.

Pathology

Documentation Requirements

Comprehensive pathology reports detailing biopsy findings.

Common Clinical Scenarios

Biopsy evaluations for suspected glomerulonephritis.

Billing Considerations

Clear correlation between pathology findings and clinical diagnosis.

Coding Guidelines

Inclusion Criteria

Use N04.3 When
  • Follow official ICD
  • CM guidelines for coding nephrotic syndrome and glomerulonephritis
  • Ensure accurate documentation of the type of nephrotic syndrome and associated conditions
  • Include details from renal biopsy and laboratory findings

Exclusion Criteria

Do NOT use N04.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

88172CPT Code

Renal biopsy, percutaneous

Clinical Scenario

Used when a renal biopsy is performed to confirm diagnosis.

Documentation Requirements

Pathology report and clinical notes detailing indications for biopsy.

Specialty Considerations

Ensure nephrology and pathology notes are aligned.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 allows for more specific coding of nephrotic syndrome and its subtypes, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 allows for more specific coding of nephrotic syndrome and its subtypes, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American Academy of Nephrology

Coding & Billing References

  • •
    American Academy of Nephrology

Frequently Asked Questions

What is the primary symptom of nephrotic syndrome?

The primary symptom of nephrotic syndrome is significant proteinuria, often accompanied by edema and low serum albumin levels.