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ICD-10 Guide
ICD-10 CodesN04.1

N04.1

Billable

Nephrotic syndrome with focal and segmental glomerular lesions

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

Code Description

ICD-10 N04.1 is a billable code used to indicate a diagnosis of nephrotic syndrome with focal and segmental glomerular lesions.

Key Diagnostic Point:

Nephrotic syndrome with focal and segmental glomerular lesions is a kidney disorder characterized by significant proteinuria, hypoalbuminemia, and edema. This condition arises from damage to the glomeruli, the filtering units of the kidneys, leading to the leakage of proteins into the urine. Focal and segmental glomerulosclerosis (FSGS) is a specific type of glomerular injury that can be primary or secondary to other conditions such as hypertension, obesity, or viral infections. Patients typically present with symptoms such as swelling in the legs and abdomen, foamy urine due to proteinuria, and may also experience hematuria. Renal biopsy is often performed to confirm the diagnosis, revealing focal and segmental lesions in the glomeruli. Management of nephrotic syndrome involves addressing the underlying cause, controlling symptoms, and may include corticosteroids, immunosuppressants, and diuretics. Regular monitoring of renal function and protein levels is essential for effective management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation between primary and secondary causes of nephrotic syndrome
  • Need for renal biopsy results to confirm diagnosis
  • Variability in clinical presentation and laboratory findings
  • Potential for co-existing conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of renal biopsy results
  • Failure to specify the type of nephrotic syndrome
  • Misclassification of primary vs. secondary causes
  • Lack of supporting lab results for proteinuria and hematuria

Specialty Focus

Medical Specialties

Nephrology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with edema, proteinuria, and renal impairment.

Billing Considerations

Ensure clarity in documenting the type of nephrotic syndrome and any underlying conditions.

Pathology

Documentation Requirements

Comprehensive reports on renal biopsy findings and histological analysis.

Common Clinical Scenarios

Biopsy evaluations for suspected glomerular diseases.

Billing Considerations

Accurate description of focal and segmental lesions is crucial for coding.

Coding Guidelines

Inclusion Criteria

Use N04.1 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the diagnosis, including the type of nephrotic syndrome and any relevant lab results
  • Include specific details from renal biopsies when applicable

Exclusion Criteria

Do NOT use N04.1 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 nephrotic syndrome with focal and segmental lesions.

Documentation Requirements

Document the indication for biopsy and findings.

Specialty Considerations

Nephrologists 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 nephrotic syndrome, enabling better tracking of disease patterns and outcomes. N04.1 provides granularity that was not available in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of nephrotic syndrome, enabling better tracking of disease patterns and outcomes. N04.1 provides granularity that was not available in ICD-9.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of nephrotic syndrome, enabling better tracking of disease patterns and outcomes. N04.1 provides granularity that was not available in ICD-9.

Resources

Clinical References

  • •
    American Academy of Nephrology

Coding & Billing References

  • •
    American Academy of Nephrology

Frequently Asked Questions

What is the primary cause of nephrotic syndrome with focal and segmental glomerular lesions?

The primary cause can vary, but focal and segmental glomerulosclerosis can be idiopathic or secondary to conditions such as obesity, hypertension, or viral infections.