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ICD-10 Guide
ICD-10 CodesN04.9

N04.9

Billable

Nephrotic syndrome with unspecified morphologic changes

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

Code Description

ICD-10 N04.9 is a billable code used to indicate a diagnosis of nephrotic syndrome with unspecified morphologic changes.

Key Diagnostic Point:

Nephrotic syndrome is a clinical condition characterized by a triad of symptoms: significant proteinuria, hypoalbuminemia, and edema. It results from various underlying causes, including glomerulonephritis, which is inflammation of the glomeruli in the kidneys. In nephrotic syndrome with unspecified morphologic changes, the specific histological findings are not detailed, making it challenging to pinpoint the exact etiology. Common causes include minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy. Patients typically present with symptoms such as swelling in the legs and abdomen, foamy urine due to protein loss, and potential complications like thromboembolism and infections. Diagnosis often involves urinalysis showing proteinuria, serum tests revealing low albumin levels, and renal biopsy to assess the underlying pathology. Management may include corticosteroids, diuretics, and angiotensin-converting enzyme (ACE) inhibitors, tailored to the underlying cause and severity of the syndrome.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in underlying causes of nephrotic syndrome
  • Need for precise documentation of clinical findings
  • Potential for overlapping symptoms with other renal conditions
  • Importance of renal biopsy results in determining treatment

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the underlying cause of nephrotic syndrome
  • Misinterpretation of renal biopsy results
  • Inconsistent coding of related conditions

Specialty Focus

Medical Specialties

Nephrology

Documentation Requirements

Detailed clinical notes on symptoms, lab results, and treatment plans are essential.

Common Clinical Scenarios

Patients presenting with edema, proteinuria, and renal function decline.

Billing Considerations

Ensure accurate documentation of renal biopsy findings and response to treatment.

Pathology

Documentation Requirements

Comprehensive reports on renal biopsy findings and histological analysis.

Common Clinical Scenarios

Evaluation of renal tissue samples for glomerular diseases.

Billing Considerations

Clear communication of findings to nephrologists for accurate coding.

Coding Guidelines

Inclusion Criteria

Use N04.9 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of symptoms, lab results, and treatment plans
  • Include details on the patient's history and any relevant comorbidities

Exclusion Criteria

Do NOT use N04.9 When
  • Exclude conditions that are not directly related to nephrotic syndrome

Related ICD-10 Codes

Related CPT Codes

Renal biopsy CPT codeCPT Code

Renal biopsy

Clinical Scenario

Used to confirm the diagnosis of nephrotic syndrome when the underlying cause is unclear.

Documentation Requirements

Document indications for biopsy, findings, and any complications.

Specialty Considerations

Nephrologists should ensure that biopsy results are communicated effectively for accurate coding.

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 patient outcomes and treatment efficacy. However, the unspecified nature of N04.9 can lead to challenges in documentation and coding accuracy.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of nephrotic syndrome, enabling better tracking of patient outcomes and treatment efficacy. However, the unspecified nature of N04.9 can lead to challenges in documentation and coding accuracy.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of nephrotic syndrome, enabling better tracking of patient outcomes and treatment efficacy. However, the unspecified nature of N04.9 can lead to challenges in documentation and coding accuracy.

Resources

Clinical References

  • •
    American Academy of Nephrology
  • •
    Kidney Disease: Improving Global Outcomes (KDIGO)

Coding & Billing References

  • •
    American Academy of Nephrology
  • •
    Kidney Disease: Improving Global Outcomes (KDIGO)

Frequently Asked Questions

What is nephrotic syndrome?

Nephrotic syndrome is a kidney disorder characterized by excessive protein loss in urine, leading to symptoms such as swelling, low protein levels in blood, and high cholesterol.

How is nephrotic syndrome diagnosed?

Diagnosis typically involves urinalysis showing significant proteinuria, blood tests indicating low albumin levels, and often a renal biopsy to determine the underlying cause.