2025 ICD-10-CM code N04.0
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Renal Disease - Glomerular diseases (N00-N08) Diseases of the genitourinary system (N00-N99) Feed
Nephrotic syndrome with minor glomerular abnormality.
Medical necessity for coding N04.0 relies on the proper diagnosis and management of nephrotic syndrome. The diagnosis requires sufficient clinical evidence, including proteinuria and edema, to warrant further investigation and treatment.The level of specificity (N04.0) necessitates documentation showing the minor nature of the glomerular abnormality, justifying its distinction from other nephrotic syndrome subtypes or related conditions.
The clinical responsibility for coding N04.0 rests with the physician or qualified healthcare professional who diagnoses and manages the patient's nephrotic syndrome.This involves a thorough history, physical exam, urinalysis, blood tests (to assess protein, albumin, lipids, creatinine), and potentially a kidney biopsy for confirmation and to evaluate the extent of glomerular damage.Ongoing management includes monitoring for complications and appropriate treatment based on the severity of the condition.
In simple words: This code describes a kidney problem called nephrotic syndrome where the kidneys leak too much protein into the urine, causing swelling, and changes in blood protein and fat levels. The changes in the kidney are small.
This ICD-10-CM code, N04.0, specifies nephrotic syndrome characterized by minimal glomerular changes.It's a renal disease where the kidneys leak significant amounts of protein into the urine, leading to edema (swelling), hypoalbuminemia (low blood albumin), and hyperlipidemia (high blood fats). The "minor glomerular abnormality" indicates that the changes seen under a microscope are subtle, differing from more severe glomerular diseases.The diagnosis requires confirmation through clinical presentation, urinalysis demonstrating significant proteinuria, and biopsy findings if needed.
Example 1: A 5-year-old child presents with edema (facial and periorbital swelling), proteinuria, and hypoalbuminemia.A kidney biopsy reveals minimal change disease (MCD), a type of nephrotic syndrome with minor glomerular changes.Code N04.0 is assigned., An adult patient with a history of hypertension and diabetes develops nephrotic syndrome.Laboratory findings show significant proteinuria and hypoalbuminemia.A kidney biopsy reveals focal segmental glomerulosclerosis (FSGS), a glomerular disease with minimal changes. In this case, both the diagnosis of nephrotic syndrome and the more specific FSGS pathology should be considered and coded appropriately., A patient with a known glomerular disease, such as IgA nephropathy, experiences a worsening of proteinuria and edema.They meet the criteria for nephrotic syndrome. While the underlying glomerular disease is known, the superimposed nephrotic syndrome and the minor glomerular changes warrant the code N04.0.
Complete medical history, physical examination findings documenting edema, laboratory results including urinalysis (showing significant proteinuria), serum albumin levels, lipid profiles, and creatinine levels.Kidney biopsy report if performed, including microscopic findings confirming the diagnosis of minor glomerular abnormality.Documentation should support the clinical diagnosis of nephrotic syndrome, and justify the selection of N04.0 over broader or more specific codes within the N00-N99 range.
** Always cross-reference with other relevant ICD-10-CM codes to ensure accurate and complete billing.Consider using additional codes to report associated conditions and comorbidities.Consult the latest ICD-10-CM coding guidelines for updates and clarifications.
- Payment Status: Active
- Specialties:Nephrology, Pediatrics (for childhood cases), Internal Medicine
- Place of Service:Office, Hospital (Inpatient or Outpatient), Urgent Care Facility, Other Place of Service (as appropriate for clinical setting)