2025 ICD-10-CM code N04.2
(Active) Effective Date: N/A Revision Date: N/A Kidney Disease - Nephrotic syndrome Diseases of the genitourinary system (N00-N99) Feed
Nephrotic syndrome with diffuse membranous glomerulonephritis.
Modifiers may be applicable depending on the circumstances of the service. Consult the payer's guidelines and the official CPT modifier guidelines for more information.
Medical necessity for the use of this code is established through confirmation of the presence of nephrotic syndrome (edema, proteinuria, hypoalbuminemia) and diffuse membranous glomerulonephritis, as supported by clinical and laboratory findings.The severity of the nephrotic syndrome determines the intensity of treatment and the need for ongoing medical management.
The clinical responsibility for this code lies with nephrologists or other specialists managing kidney diseases.Their role includes diagnosing the condition through clinical evaluation, laboratory tests (including urinalysis and blood tests), and potentially kidney biopsy. They manage the treatment based on the severity of the nephrotic syndrome and any underlying causes, which might involve medications, dietary modifications, and monitoring of kidney function.
In simple words: This code describes a kidney problem where there's swelling, protein in the urine, and low levels of a specific protein in the blood. This is because of a condition affecting the kidneys' filtering parts, causing them to leak protein.
N04.2, Nephrotic syndrome with diffuse membranous glomerulonephritis, in the ICD-10-CM classification system, refers to a kidney disorder characterized by the nephrotic syndrome (severe edema, proteinuria, hypoalbuminemia) in conjunction with diffuse membranous glomerulonephritis.Membranous glomerulonephritis is a type of kidney disease affecting the glomeruli (filtering units of the kidneys) where immune complexes deposit within the glomerular basement membrane, thickening it and causing protein to leak into the urine. The diffuse nature indicates the involvement of many glomeruli.The nephrotic syndrome is a constellation of symptoms stemming from the significant protein loss, including edema (swelling), protein in the urine (proteinuria), and low levels of albumin in the blood (hypoalbuminemia).This code may be further specified as primary or secondary membranous nephropathy depending on the underlying cause.Associated conditions, complications, and other relevant clinical details should also be documented.
Example 1: A 45-year-old male patient presents with significant edema, proteinuria exceeding 3.5 g/day, and hypoalbuminemia. A kidney biopsy reveals diffuse membranous glomerulonephritis. This diagnosis accurately reflects the patient's clinical picture and necessitates this ICD-10 code., A 60-year-old female patient diagnosed with lupus nephritis experiences a nephrotic syndrome exacerbation. This secondary membranous glomerulonephritis warrants code N04.2, along with an additional code specifying the underlying lupus nephritis., A 28-year-old patient with a history of hepatitis B is found to have proteinuria and edema.Kidney biopsy shows diffuse membranous glomerulonephritis.The code N04.2 is used along with an additional code to reflect the underlying hepatitis B as the cause of the kidney disease.
Detailed clinical history, physical examination findings (especially edema), urinalysis with quantification of proteinuria, serum albumin levels, and ideally, a kidney biopsy report confirming diffuse membranous glomerulonephritis are necessary for proper coding.Additional documentation should include results of any relevant investigations, such as blood tests for autoimmune diseases or infections that could be the underlying cause.Also document the severity of the nephrotic syndrome and treatment response.
** Always refer to the most current ICD-10-CM coding manual and guidelines for the most accurate coding practices.This information is for guidance only and should not be considered a substitute for professional medical coding advice.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Nephrology
- Place of Service:Office, Hospital (inpatient and outpatient), Ambulatory Surgical Center