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ICD-10 Guide
ICD-10 CodesQ61.5

Q61.5

Billable

Medullary cystic kidney

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 Q61.5 is a billable code used to indicate a diagnosis of medullary cystic kidney.

Key Diagnostic Point:

Medullary cystic kidney disease is a rare genetic disorder characterized by the presence of cysts in the renal medulla, leading to progressive renal dysfunction. This condition is often inherited in an autosomal dominant pattern and is associated with a gradual decline in kidney function, typically manifesting in adolescence or early adulthood. Patients may present with symptoms such as polyuria, nocturia, and hypertension. The cysts develop in the renal medulla and can lead to renal tubular dysfunction, resulting in electrolyte imbalances and metabolic acidosis. Diagnosis is often confirmed through imaging studies, such as ultrasound or MRI, which reveal the characteristic cystic changes in the kidneys. Genetic testing may also be utilized to identify mutations in genes associated with the condition. Management focuses on monitoring renal function, controlling blood pressure, and addressing complications as they arise. In severe cases, renal replacement therapy may be necessary.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of symptoms
  • Need for genetic testing and interpretation
  • Differentiation from other renal cystic diseases
  • Potential for coexisting congenital anomalies

Audit Risk Factors

  • Inadequate documentation of genetic testing results
  • Failure to document family history of renal disease
  • Misclassification of cystic kidney diseases
  • Lack of clarity in the clinical presentation

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation should include growth parameters, developmental milestones, and specific renal function tests.

Common Clinical Scenarios

Common scenarios include routine monitoring of renal function in children with known familial history of medullary cystic kidney disease.

Billing Considerations

Consideration must be given to the age of onset and the impact on growth and development.

Genetics

Documentation Requirements

Genetic documentation should include details of genetic counseling sessions, test results, and family pedigree.

Common Clinical Scenarios

Scenarios may involve genetic counseling for families with a history of medullary cystic kidney disease.

Billing Considerations

Accurate coding requires understanding of the genetic basis and inheritance patterns.

Coding Guidelines

Inclusion Criteria

Use Q61.5 When
  • Follow the official ICD
  • CM guidelines for coding congenital malformations, ensuring accurate documentation of the condition's clinical features and any associated anomalies

Exclusion Criteria

Do NOT use Q61.5 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

81228CPT Code

Genetic testing for medullary cystic kidney disease

Clinical Scenario

Used when genetic confirmation of the diagnosis is required.

Documentation Requirements

Documentation of clinical suspicion and family history.

Specialty Considerations

Genetic counseling may be necessary for families.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital conditions, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    National Kidney Foundation

Coding & Billing References

  • •
    National Kidney Foundation

Frequently Asked Questions

What is the significance of genetic testing in medullary cystic kidney disease?

Genetic testing is crucial for confirming the diagnosis, understanding inheritance patterns, and providing appropriate counseling for affected families.