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N18.4

Chronic kidney disease, stage 4 (severe)

Diseases of the genitourinary system Billable
Quick Reference
eGFR 15-29 mL/min/1.73m² for ≥3 months

Clinical Information

When to Use This Code

eGFR 15-29 mL/min/1.73m² for ≥3 months

Common Clinical Scenarios

  • Advanced CKD management
  • Nephrology referral for dialysis planning
  • Pre-dialysis education
  • Renal replacement therapy evaluation

Documentation Requirements

  • Document eGFR value (15-29 range)
  • Record underlying cause (diabetic, hypertensive, GN)
  • Note complications (anemia, bone disease, acidosis)
  • Specify if dialysis or transplant being considered

Coding Guidelines

Inclusion Terms

These terms are included in this code:

CKD stage 4Severe chronic kidney diseasePre-dialysis CKD

Exclusion Terms

Do NOT use this code for:

  • CKD stage 3 (N18.3)
  • CKD stage 5/ESRD (N18.5, N18.6)
  • Acute kidney injury (N17.-)

Coding Notes

Stage based on eGFR: 15-29 mL/min
High risk for dialysis within 1-2 years
Dialysis access planning critical

Related ICD-10 Codes

Consider these related codes based on patient presentation:

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Code Details

Code
N18.4
Category
Diseases of the genitourinary system
Billable Status
Billable

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