ICD Code N18.6

ICD code N18.6 is used to classify and code the diagnosis of end stage renal disease (ESRD), which is the final stage of chronic kidney disease where the kidneys can no longer function adequately to meet the body's needs, often requiring dialysis or a kidney transplant.

1. Chronic Kidney Disease (CKD) Stage 5: The patient must have progressed to the most advanced stage of chronic kidney disease, where kidney function is severely impaired.

2. Glomerular Filtration Rate (GFR) Less Than 15 mL/min/1.73 m²: The patient's GFR, a key indicator of kidney function, should be consistently below 15, indicating severe kidney damage.

3. Dependence on Dialysis: The patient requires regular dialysis treatments to perform the functions of the kidneys, such as filtering waste and excess fluids from the blood.

4. Preparation for Kidney Transplant: The patient is being evaluated or is on a waiting list for a kidney transplant due to irreversible kidney failure.

5. Symptoms of Uremia: The patient exhibits symptoms associated with the accumulation of waste products in the blood, such as fatigue, nausea, vomiting, confusion, or muscle cramps.

6. Fluid Overload: The patient experiences significant fluid retention, leading to swelling in the legs, ankles, or feet, and potentially causing high blood pressure or heart complications.

7. Electrolyte Imbalance: The patient has imbalances in electrolytes such as potassium, sodium, or calcium, which can lead to serious health issues if not managed properly.

8. Anemia: The patient presents with anemia due to reduced erythropoietin production by the failing kidneys, leading to fatigue and weakness.

9. Bone Disease: The patient may have renal osteodystrophy, a bone disorder resulting from chronic kidney disease, characterized by bone pain and fractures.

10. Persistent Proteinuria: The patient has ongoing protein loss in the urine, indicating significant kidney damage and dysfunction.

For the ICD code N18.6, which pertains to end stage renal disease, the relevant CPT codes that may be applicable include:

1. 90935 - Hemodialysis procedure with single evaluation by a physician or other qualified healthcare professional.

2. 90937 - Hemodialysis procedure requiring repeated evaluation(s) with or without substantial revision of dialysis prescription.

3. 90945 - Dialysis procedure other than hemodialysis (e.g., peritoneal dialysis), with single evaluation by a physician or other qualified healthcare professional.

4. 90947 - Dialysis procedure other than hemodialysis, requiring repeated evaluation(s) with or without substantial revision of dialysis prescription.

5. 90960 - End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified healthcare professional per month.

6. 90961 - ESRD related services monthly, for patients 20 years of age and older; with 2-3 face-to-face visits by a physician or other qualified healthcare professional per month.

7. 90962 - ESRD related services monthly, for patients 20 years of age and older; with 1 face-to-face visit by a physician or other qualified healthcare professional per month.

8. 90963 - ESRD related services for home dialysis per full month; for patients younger than 2 years of age.

9. 90964 - ESRD related services for home dialysis per full month; for patients 2-11 years of age.

10. 90965 - ESRD related services for home dialysis per full month; for patients 12-19 years of age.

11. 90966 - ESRD related services for home dialysis per full month; for patients 20 years of age and older.

These CPT codes are typically used in the context of billing for services related to the management and treatment of end stage renal disease. It is important for healthcare providers to select the appropriate CPT code based on the specific services rendered and the patient's age and treatment plan.

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