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ICD-10 Guide
ICD-10 CodesN05.1

N05.1

Billable

Unspecified nephritic syndrome with focal and segmental glomerular lesions

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

Code Description

ICD-10 N05.1 is a billable code used to indicate a diagnosis of unspecified nephritic syndrome with focal and segmental glomerular lesions.

Key Diagnostic Point:

Unspecified nephritic syndrome with focal and segmental glomerular lesions is characterized by the presence of nephritic syndrome symptoms, including hematuria, proteinuria, and hypertension, alongside specific pathological findings in the glomeruli. This condition often presents with a combination of nephritic and nephrotic features, leading to significant renal impairment. The focal and segmental lesions indicate that only certain parts of the glomeruli are affected, which can complicate diagnosis and management. Patients may experience varying degrees of renal dysfunction, and renal biopsy is often necessary to confirm the diagnosis and assess the extent of glomerular damage. Management typically involves addressing the underlying cause, controlling blood pressure, and managing proteinuria, often requiring a multidisciplinary approach involving nephrologists and primary care providers. Long-term monitoring is essential to prevent progression to end-stage renal disease.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Need for renal biopsy to confirm diagnosis
  • Differentiation from other types of nephritic and nephrotic syndromes
  • Potential for overlapping conditions

Audit Risk Factors

  • Inadequate documentation of renal biopsy results
  • Failure to document clinical symptoms such as hematuria and proteinuria
  • Misclassification of nephritic versus nephrotic syndrome
  • Lack of follow-up documentation on renal function

Specialty Focus

Medical Specialties

Nephrology

Documentation Requirements

Detailed clinical notes on symptoms, lab results, and biopsy findings.

Common Clinical Scenarios

Patients presenting with unexplained hematuria and proteinuria, requiring renal biopsy.

Billing Considerations

Ensure accurate documentation of glomerular lesions and response to treatment.

Primary Care

Documentation Requirements

Comprehensive history and physical examination notes, including referral details to nephrology.

Common Clinical Scenarios

Initial evaluation of patients with suspected kidney disease.

Billing Considerations

Document any referrals and follow-up care plans for nephrology.

Coding Guidelines

Inclusion Criteria

Use N05.1 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of symptoms, lab results, and biopsy findings
  • Include any relevant comorbidities and ensure that the diagnosis is supported by clinical evidence

Exclusion Criteria

Do NOT use N05.1 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

Document indication for biopsy, findings, and any complications.

Specialty Considerations

Nephrology specialists should ensure thorough documentation of the biopsy process.

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, improving the ability to capture the nuances of renal pathology and treatment needs. This specificity aids in better patient management and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of nephritic syndromes, improving the ability to capture the nuances of renal pathology and treatment needs. This specificity aids in better patient management and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of nephritic syndromes, improving the ability to capture the nuances of renal pathology and treatment needs. This specificity aids in better patient management and resource allocation.

Resources

Clinical References

  • •
    Kidney Disease: Improving Global Outcomes (KDIGO)

Coding & Billing References

  • •
    Kidney Disease: Improving Global Outcomes (KDIGO)

Frequently Asked Questions

What are the key symptoms of nephritic syndrome?

Key symptoms include hematuria, proteinuria, hypertension, and edema. Patients may also experience fatigue and decreased urine output.