Chapter 14.
Diseases of
Genitourinary System (N00–
N99)
Chapter-specific Guidelines with
Coding Examples
The chapter-specific guidelines from the ICD-10-CM Official
Guidelines for Coding and Reporting have been provided
below. Along with these guidelines are coding examples,
contained in the shaded boxes, that have been developed to
help illustrate the coding and/or sequencing guidance found
in these guidelines.
a. Chronic kidney disease
1) Stages of chronic kidney disease (CKD)
The ICD-10-CM classifies CKD based on severity. The
severity of CKD is designated by stages 1-5. Stage 2,
code N18.2, equates to mild CKD; stage 3, codes
N18.30-N18.32, equate to moderate CKD; and stage 4,
code N18.4, equates to severe CKD. Code N18.6, End
stage renal disease (ESRD), is assigned when the
provider has documented end-stage renal disease
(ESRD).
If both a stage of CKD and ESRD are documented,
assign code N18.6 only.
Stage 5 chronic kidney disease with ESRD requiring
chronic dialysis
N18.6 End stage renal disease
Z99.2 Dependence on renal dialysis
Explanation: The diagnostic statement indicates the
patient has chronic kidney disease, documented
both as stage 5 and as ESRD requiring chronic
dialysis. Code N18.6 End stage renal disease (ESRD),
is assigned when the provider has documented end-
stage-renal disease (ESRD). If both a stage of CKD
and ESRD are documented, assign code N18.6 only.
2) Chronic kidney disease and kidney transplant
status
Patients who have undergone kidney transplant may
still have some form of chronic kidney disease (CKD)
because the kidney transplant may not fully restore
kidney function. Therefore, the presence of CKD alone
does not constitute a transplant complication. Assign
the appropriate N18 code for the patient’s stage of
CKD and code Z94.0, Kidney transplant status. If a
transplant complication such as failure or rejection or
other transplant complication is documented, see
section I.C.19.g for information on coding complications
of a kidney transplant. If the documentation is unclear
as to whether the patient has a complication of the
transplant, query the provider.
Patient with residual chronic kidney disease stage 1
after kidney transplant
N18.1 Chronic kidney disease, stage 1
Z94.0 Kidney transplant status
Explanation: Patients who have undergone kidney
transplant may still have some form of chronic
kidney disease (CKD) because the kidney transplant
may not fully restore kidney function. The presence
of CKD alone does not constitute a transplant
complication. Assign the appropriate N18 code for
the patient’s stage of CKD and code Z94.0 Kidney
transplant status.
3) Chronic kidney disease with other conditions
Patients with CKD may also suffer from other serious
conditions, most commonly diabetes mellitus and
hypertension. The sequencing of the CKD code in
relationship to codes for other contributing conditions
is based on the conventions in the Tabular List.
See I.C.9. Hypertensive chronic kidney disease.
See I.C.19. Chronic kidney disease and kidney
transplant complications.
Type 1 diabetic chronic kidney disease, stage 2
E10.22 Type 1 diabetes mellitus with diabetic
chronic kidney disease
N18.2 Chronic kidney disease, stage 2 (mild)
Explanation: Patients with CKD may also suffer from
other serious conditions such as diabetes mellitus.
The sequencing of the CKD code in relationship to
codes for other contributing conditions is based on
the conventions in the Tabular List. Diabetic CKD
code E10.22 includes an instructional note to “Use
additional code to identify stage of chronic kidney
disease (N18.1–N18.6),” thus providing sequencing
direction.
