2025 ICD-10-CM code N18.5
(Active) Effective Date: N/A Diseases of the genitourinary system - N17-N19 N00-N99 Feed
Chronic kidney disease, stage 5.
Medical necessity for services related to N18.5 is established by the presence of end-stage renal disease requiring dialysis or transplant to maintain life. Conservative management may be medically necessary when dialysis or transplant are not appropriate due to the patient's overall health condition or personal preferences.Detailed documentation supporting the chosen treatment plan is crucial.
Nephrologists are primarily responsible for the diagnosis, management, and treatment of patients with stage 5 CKD. This includes prescribing medications, ordering and interpreting diagnostic tests, managing dialysis or coordinating kidney transplant care.
In simple words: Stage 5 chronic kidney disease means your kidneys have almost completely stopped working.Your body is not able to get rid of waste products, which can make you very sick.Treatment at this stage usually involves dialysis or a kidney transplant.
Chronic kidney disease (CKD) stage 5 signifies kidney failure, also known as end-stage renal disease (ESRD).At this stage, the kidneys have lost nearly all their ability to filter waste and excess fluids from the blood. This leads to a build-up of toxins in the body and requires dialysis or a kidney transplant for survival.
Example 1: A 65-year-old patient with a history of diabetes and hypertension presents with fatigue, shortness of breath, and swelling in the extremities.Blood tests reveal an eGFR of 10 ml/min, indicating stage 5 CKD.The patient is initiated on hemodialysis., A 40-year-old patient with a history of polycystic kidney disease experiences a rapid decline in kidney function and is diagnosed with stage 5 CKD. After evaluation, they are placed on the waiting list for a kidney transplant., A 70-year-old patient with long-standing CKD gradually progresses to stage 5. Due to other health complications, they opt for conservative management instead of dialysis or transplant, focusing on symptom control and quality of life.
Documentation for N18.5 should include the eGFR value (less than 15 ml/min), supporting laboratory data, documentation of kidney damage, the presence of associated symptoms (e.g., fatigue, swelling, shortness of breath), and the chosen treatment plan (dialysis, transplant, or conservative management).If a patient has an underlying condition like diabetes or hypertension, this should also be documented.
** It's crucial to document the patient's current treatment modality (dialysis, transplant evaluation, conservative care) and any associated medical conditions impacting treatment decisions.
- Specialties:Nephrology, Internal Medicine, Transplant Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Skilled Nursing Facility, Hospice, Home