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ICD-10 Guide
ICD-10 CodesN04.4

N04.4

Billable

Nephrotic syndrome with diffuse endocapillary proliferative glomerulonephritis

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

Code Description

ICD-10 N04.4 is a billable code used to indicate a diagnosis of nephrotic syndrome with diffuse endocapillary proliferative glomerulonephritis.

Key Diagnostic Point:

Nephrotic syndrome is characterized by a triad of symptoms: significant proteinuria, hypoalbuminemia, and edema. When associated with diffuse endocapillary proliferative glomerulonephritis, it indicates an inflammatory process affecting the glomeruli, leading to increased permeability and resultant protein loss in urine. Patients typically present with symptoms such as swelling, particularly in the legs and around the eyes, and may also experience hematuria (blood in urine). Renal biopsy findings often reveal diffuse hypercellularity, glomerular capillary loop thickening, and immune complex deposition. Management in nephrology includes corticosteroids, immunosuppressants, and supportive care to control symptoms and prevent complications such as infections and thromboembolic events. Regular monitoring of renal function and proteinuria is essential to assess 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 precise documentation of clinical findings and renal biopsy results.
  • Potential for overlapping symptoms with other renal conditions.

Audit Risk Factors

  • Inadequate documentation of renal biopsy findings.
  • Failure to document associated symptoms like hematuria.
  • Lack of clarity in distinguishing between nephrotic syndrome types.
  • Insufficient 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 impairment.

Billing Considerations

Ensure renal biopsy results are clearly documented to support diagnosis.

Pathology

Documentation Requirements

Comprehensive reports on renal biopsy findings.

Common Clinical Scenarios

Evaluation of renal tissue for glomerular diseases.

Billing Considerations

Pathology reports should correlate with clinical findings for accurate coding.

Coding Guidelines

Inclusion Criteria

Use N04.4 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the diagnosis and any associated conditions
  • Include details on the type of nephrotic syndrome and any relevant laboratory findings

Exclusion Criteria

Do NOT use N04.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

88172CPT Code

Renal biopsy

Clinical Scenario

Used when a renal biopsy is performed to confirm diagnosis.

Documentation Requirements

Biopsy report must be included in the patient's medical record.

Specialty Considerations

Nephrologists should ensure that the biopsy findings correlate with clinical symptoms.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of nephrotic syndrome, improving the accuracy of diagnoses and treatment tracking. N04.4 provides a clear distinction for nephrotic syndrome associated with diffuse endocapillary proliferative glomerulonephritis, which aids in clinical management and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of nephrotic syndrome, improving the accuracy of diagnoses and treatment tracking. N04.4 provides a clear distinction for nephrotic syndrome associated with diffuse endocapillary proliferative glomerulonephritis, which aids in clinical management and research.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of nephrotic syndrome, improving the accuracy of diagnoses and treatment tracking. N04.4 provides a clear distinction for nephrotic syndrome associated with diffuse endocapillary proliferative glomerulonephritis, which aids in clinical management and research.

Resources

Clinical References

  • •
    American Academy of Nephrology

Coding & Billing References

  • •
    American Academy of Nephrology

Frequently Asked Questions

What are the key symptoms of nephrotic syndrome?

Key symptoms include significant proteinuria, edema, and hypoalbuminemia. Patients may also experience hematuria and fatigue.

How is diffuse endocapillary proliferative glomerulonephritis diagnosed?

Diagnosis is typically made through renal biopsy, which reveals hypercellularity and immune complex deposition in the glomeruli.