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v1.0.0
ICD-10 Guide
ICD-10 CodesN11.0

N11.0

Billable

Nonobstructive reflux-associated chronic pyelonephritis

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

Code Description

ICD-10 N11.0 is a billable code used to indicate a diagnosis of nonobstructive reflux-associated chronic pyelonephritis.

Key Diagnostic Point:

Nonobstructive reflux-associated chronic pyelonephritis is a condition characterized by recurrent kidney infections due to the backflow of urine from the bladder into the kidneys, known as vesicoureteral reflux (VUR). This condition leads to chronic inflammation and scarring of the renal interstitium, which can result in renal impairment over time. Patients may present with symptoms such as flank pain, fever, and urinary symptoms like dysuria or increased frequency. Diagnosis typically involves imaging studies such as ultrasound or voiding cystourethrogram (VCUG) to assess for reflux and renal damage. Management often includes antibiotic prophylaxis to prevent recurrent urinary tract infections (UTIs) and may require surgical intervention in severe cases to correct the anatomical defect causing reflux. Chronic pyelonephritis can also be associated with interstitial nephritis and hydronephrosis, complicating the clinical picture. Understanding the underlying causes and appropriate management strategies is crucial for preventing long-term renal damage.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between obstructive and nonobstructive causes of pyelonephritis
  • Understanding the relationship between reflux and chronic kidney disease
  • Identifying associated conditions such as interstitial nephritis and hydronephrosis
  • Navigating antibiotic management protocols for recurrent UTIs

Audit Risk Factors

  • Inadequate documentation of reflux status
  • Failure to document recurrent UTIs
  • Lack of imaging studies to support diagnosis
  • Misclassification of acute versus chronic conditions

Specialty Focus

Medical Specialties

Nephrology

Documentation Requirements

Detailed history of urinary symptoms, imaging results, and treatment plans.

Common Clinical Scenarios

Patients with recurrent UTIs and chronic kidney disease due to reflux.

Billing Considerations

Ensure documentation reflects the chronic nature and any renal impairment.

Urology

Documentation Requirements

Surgical notes if corrective procedures are performed, imaging studies, and follow-up care.

Common Clinical Scenarios

Patients requiring surgical intervention for severe reflux.

Billing Considerations

Document anatomical abnormalities and surgical outcomes.

Coding Guidelines

Inclusion Criteria

Use N11.0 When
  • Follow official ICD
  • CM guidelines for coding chronic conditions
  • Ensure that documentation supports the chronic nature of the pyelonephritis and any associated conditions
  • Include relevant imaging and laboratory results

Exclusion Criteria

Do NOT use N11.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76700CPT Code

Ultrasound, abdomen, complete

Clinical Scenario

Used to evaluate kidney structure in patients with chronic pyelonephritis.

Documentation Requirements

Document indications for ultrasound and findings.

Specialty Considerations

Nephrology and Urology may require specific imaging protocols.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of chronic conditions like N11.0, improving the accuracy of patient records and facilitating better management of chronic kidney diseases.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of chronic conditions like N11.0, improving the accuracy of patient records and facilitating better management of chronic kidney diseases.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of chronic conditions like N11.0, improving the accuracy of patient records and facilitating better management of chronic kidney diseases.

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 primary cause of nonobstructive reflux-associated chronic pyelonephritis?

The primary cause is vesicoureteral reflux, where urine flows backward from the bladder into the kidneys, leading to recurrent infections and chronic kidney damage.