Chapter 14:
Diseases of Genitourinary
System (N00-N99)
Urinary system anatomy
Function of urinary system
• urinary system filters blood by eliminating extra water and salt, toxins
and other waste products.
• Different parts of the urinary system perform tasks, including:
• Filtering blood.
• maintain water and acid base balance in blood
• Regulate blood volume and blood pressure.
• Separating the toxins you don’t need from the nutrients you do need.
• Storing urine and excrete out of your body.
Common conditions and diseases
affect the urinary system
• Infections
• Kidney stones
• Urinary incontinence
• Urinary tract obstraction
• CKD-chronic kidney disease-Kidney disease is a common and serious
condition that affects your urinary system. The most common causes
of chronic kidney disease (CKD) are high blood pressure and
diabetes. . Kidney disease can lead to kidney failure. Kidney failure
may require dialysis or a kidney transplant
[Link] kidney disease-Stages
• The ICD-10-CM classifies CKD based on severity. The severity of CKD is designated by stages 1-
5.
• stage1, Code N18.1
• Stage 2, code N18.2, equates to mild CKD.
• stage 3, codes N18.30-N18.32, equate to moderate CKD
• stage 4, code N18.4, equates to severe CKD.
• Stage 5, Code N18.5
• Stage 6 Code N18.6, End stage renal disease (ESRD), is assigned when the provider has
documented end stage renal disease (ESRD).
• If both lower stage of CKD and ESRD are documented, assign code N18.6 only.
• Note- if patient is dialysis dependent with stage 5 CKD then consider only stage 6 (N18.6).
[Link] 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 notfully restore kidney function. Therefore, the presence of CKD
alone does not constitute a transplant complication.
• 1st code: N18 code for the patients stage of CKD and
• 2nd code: Z94.0, as Kidney transplant status
• additional code : Complication code such as failure or rejection,
infection if documented -T86.10 -T86.19
[Link] 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.
• Hypertensive chronic kidney disease.
• Chronic kidney disease with Diabetes mellitus.
• Hypertensive heart and CKD
Hypertension with CKD
• when the pateint has both HTN with CKD, specific combination codes are there to indicate
both conditions simultaneously.
• I12.0-Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage
renal disease
• I12.9- Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney
disease, or unspecified chronic kidney disease
• I13.0-Hypertensive heart and chronic kidney disease with heart failure and stage 1 through
stage 4 chronic kidney disease, or unspecified chronic kidney disease
• I13.11-Hypertensive heart and chronic kidney disease without heart failure, with stage 5
chronic kidney disease, or end stage renal disease
• I13.2-Hypertensive heart and chronic kidney disease with heart failure and with stage 5
chronic kidney disease, or end stage renal disease
Hypertension with CKD
• Sequencing: When the CKD is documented with HTN, the appropriate
code from I12-I13 should be first.
• Then additional code from N18- to specify the stage of CKD.
• Example- hypertensive pateint comes with mild stage of CKD.
• 1st code- I12.9
• 2nd code-N18.2
• Note-3rd code- dialysis satus code if the pateint is dialysis dependent
with ESRD- Z99.2
Chronic kidney disease with Heart
failure
When CKD is present with heart failure both condition should coded
for Hypertensive heart with CKD , a combination code from I13should
be used.
Additional codes-If the patient also as the heart failure use code from
I50. - to specify the type of heart failure.
CKD with diabetes
• when CKD due to diabetes codes from E08-E13 should be used to represent
the type of diabetes and to indicate CKD is a complication.
• ICD 10 combination codes:
• E08.22-Diabetes mellitus due to underlying condition with diabetic chronic
kidney disease
• E09.22-Drug or chemical induced diabetes mellitus with diabetic chronic
kidney disease
• E10.22-Type 1 diabetes mellitus with diabetic chronic kidney disease
• E11.22-Type 2 diabetes mellitus with diabetic chronic kidney disease
• E13.22-Other specified diabetes mellitus with diabetic chronic kidney disease
CKD with diabetes
• Sequencing: the appropriate diabetic code should be first( E08-E13)
followed by the stage of CKD.
• Example- Pateint comes with CKD , he also have Diabetes mellitus.
• 1 code- E11.22
• 2 code- N18.9
• Note- for CKD stage 6 add 3rd code Z99.2 to indicate the patient is in
dialysis.
Chronic kidney disease with other conditions
if CKD is documented with other conditions such as gout, lupus
nephritis or other kidney related condition
we should use the appropriate ICD 10 code for condition follow with
the stage of CKD -N18
Thank you