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ICD-10 Guide
ICD-10 CodesChapter 14: Diseases of the genitourinary systemN05

N05

Billable

Unspecified nephritic syndrome

Chapter 14:Diseases of the genitourinary system

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

Code Description

ICD-10 N05 is a billable code used to indicate a diagnosis of unspecified nephritic syndrome.

Key Diagnostic Point:

Unspecified nephritic syndrome refers to a clinical condition characterized by a combination of symptoms that indicate inflammation of the kidneys, particularly affecting the glomeruli. This syndrome is often associated with significant proteinuria (excess protein in urine), hematuria (blood in urine), and varying degrees of renal impairment. Patients may present with edema, hypertension, and renal dysfunction. The underlying causes can be diverse, including infections, autoimmune diseases, and systemic conditions. Diagnosis typically involves a thorough clinical evaluation, urinalysis showing proteinuria and hematuria, and may necessitate renal biopsy to ascertain the specific type of glomerulonephritis. Management strategies often include controlling blood pressure, reducing proteinuria, and addressing the underlying cause, which may involve immunosuppressive therapy or other targeted treatments. The unspecified nature of this code indicates that the specific etiology of the nephritic syndrome has not been determined, necessitating careful documentation and consideration of differential diagnoses.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes leading to nephritic syndrome
  • Need for comprehensive clinical documentation to support diagnosis
  • Potential overlap with nephrotic syndrome and other renal conditions
  • Variability in clinical presentation and laboratory findings

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the underlying cause of nephritic syndrome
  • Misclassification of nephritic syndrome as nephrotic syndrome
  • Lack of supporting laboratory results in the medical record

Specialty Focus

Medical Specialties

Nephrology

Documentation Requirements

Detailed clinical notes including symptoms, laboratory results, and treatment plans.

Common Clinical Scenarios

Patients presenting with edema, hypertension, and abnormal urinalysis findings.

Billing Considerations

Ensure that all relevant diagnostic tests and their results are documented to support the diagnosis.

Primary Care

Documentation Requirements

Comprehensive patient history and physical examination findings, including any referrals to nephrology.

Common Clinical Scenarios

Initial evaluation of patients with suspected kidney disease based on routine lab tests.

Billing Considerations

Document any follow-up care or referrals to specialists for further evaluation.

Coding Guidelines

Inclusion Criteria

Use N05 When
  • According to ICD
  • 10 coding guidelines, N05 should be used when the nephritic syndrome is not specified further
  • Coders must ensure that the documentation supports the diagnosis and that any related conditions are also coded appropriately

Exclusion Criteria

Do NOT use N05 When
  • Exclusion criteria include specific types of glomerulonephritis that have their own codes

Related CPT Codes

Renal biopsy CPT codeCPT Code

Renal biopsy

Clinical Scenario

When a renal biopsy is performed to determine the cause of nephritic syndrome.

Documentation Requirements

Document indication for biopsy, findings, and any complications.

Specialty Considerations

Nephrology specialists should ensure that the biopsy results are clearly linked to the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of nephritic syndromes, but N05 remains a catch-all for unspecified cases. This can lead to challenges in accurately capturing the complexity of renal diseases, emphasizing the need for thorough documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of nephritic syndromes, but N05 remains a catch-all for unspecified cases. This can lead to challenges in accurately capturing the complexity of renal diseases, emphasizing the need for thorough documentation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of nephritic syndromes, but N05 remains a catch-all for unspecified cases. This can lead to challenges in accurately capturing the complexity of renal diseases, emphasizing the need for thorough documentation.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between nephritic syndrome and nephrotic syndrome?

Nephritic syndrome is characterized by hematuria, proteinuria, and hypertension, while nephrotic syndrome primarily involves significant proteinuria, hypoalbuminemia, and edema without hematuria.