2025 ICD-10-CM code N04
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the genitourinary system - Glomerular diseases XIV Diseases of the genitourinary system Feed
Nephrotic syndrome, encompassing various glomerular diseases characterized by proteinuria, hypoalbuminemia, and edema.
Modifiers may be applicable depending on the circumstances of the encounter (e.g., place of service, type of service). Consult your local payer guidelines and relevant coding manuals.
Medical necessity for assigning N04 is established through clinical findings supporting the diagnosis of nephrotic syndrome, such as the presence of proteinuria, hypoalbuminemia, and edema.Additional testing such as renal biopsy might be required depending on the clinical situation to determine the underlying glomerular pathology and guide further management.
The clinical responsibility for a patient with nephrotic syndrome involves diagnosis, monitoring of the disease progression, management of symptoms (edema, hypertension), and treatment of the underlying cause.Referral to a nephrologist may be necessary for complex cases.
In simple words: Nephrotic syndrome is a kidney disorder where the kidneys leak too much protein into the urine, causing swelling and other symptoms. This happens because of damage to the tiny filtering units in the kidneys.It can be caused by different reasons and needs proper medical attention.
Nephrotic syndrome is a clinical condition characterized by significant proteinuria (excretion of protein in the urine), hypoalbuminemia (low levels of albumin in the blood), and edema (swelling due to fluid retention).It results from damage to the glomeruli, the filtering units of the kidneys.The underlying glomerular pathology can vary, leading to subcategories such as minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and others.Nephrotic syndrome can be primary (idiopathic) or secondary to other conditions like systemic lupus erythematosus, diabetes, or infections.Clinical presentation often includes hyperlipidemia and lipiduria.
Example 1: A 5-year-old child presents with periorbital edema, ascites, and frothy urine.Laboratory tests reveal heavy proteinuria and hypoalbuminemia.Renal biopsy shows minimal change disease.ICD-10 code N04 is assigned., A 40-year-old woman with a history of systemic lupus erythematosus develops nephrotic syndrome, confirmed by laboratory findings and renal biopsy showing membranous glomerulonephritis.ICD-10 code N04.2 is assigned in addition to codes related to SLE., A 65-year-old diabetic patient presents with edema and proteinuria.Further investigation reveals diabetic nephropathy. The physician assigns ICD-10 code N04 alongside the codes specifying diabetic kidney disease.
Complete history and physical examination, urinalysis (including protein quantification), serum albumin level, lipid profile, and potentially a renal biopsy depending on the clinical picture.Any underlying causes need to be thoroughly documented.
** Always code to the highest level of specificity available based on the clinical documentation.In outpatient care, ensure use of the correct diagnostic confidence indicator, following local guidelines.
- Revenue Code: This will vary depending on the specific services provided and the payer. Consult your local payer guidelines and revenue code mapping.
- RVU: RVUs will depend on the services rendered related to diagnosing and managing nephrotic syndrome. Consult the appropriate fee schedule for specific values.
- Global Days: Not applicable. This code is for a diagnosis, not a procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable. This is a diagnostic code.
- Fee Schedule: Not applicable. This code represents a diagnosis; it does not have a fee schedule.
- Specialties:Nephrology, Pediatrics, Internal Medicine
- Place of Service:Office, Hospital (Inpatient and Outpatient), Clinic, Other Place of Service (depending on the setting of care).