Question 1

ICD-10-CM Alphabetic Index: Syndrome, nephritic – see also Nephritis. Nephritis, nephritic (albuminuric) (azotemic) (congenital) (disseminated) (epithelial) (familial) (focal) (granu-lomatous) (hemorrhagic) (infantile) (nonsuppurative) (uremic) > chronic > with > diffuse membranous glomerulonephritis.

Rationale: The indexing of this code can be somewhat confusing. If you go to Syndrome, nephritic, there is a note to see also Nephritis. See also notes can be used if the choice we are looking for is not in any of the subterms.

There are also terms for Nephrotic Syndrome, which causes a different path. Nephritic syndrome and nephrotic syndrome are similar but different.

There are many different choices in the Glomerular Diseases (N00-N08) block.

A careful review of the category choices in this block is helpful. Nephritic syndrome is not a specific diagnosis, but a clinical syndrome characterized by several signs. Its prognosis depends on the underlying etiology.

The proteinuria and hematuria are symptoms and would not be coded.

Question 2

Rationale:

ICD-10-CM Alphabetic Index: Cystitis (suppurative) > With > Hematuria > N30.01.

The frequent urination and pain are integral to the cystitis and not assigned codes.

A note at category N30 states to “Use additional code to identify infectious agent” (B95-B97). This code is never in the first position.

Question 3

Rationale:

ICD-10-CM Alphabetic Index: Menorrhagia > Premenopausal > N92.4

Subcategory N92.4, Excessive bleeding in the premenopausal period includes climacteric, menopausal, preclimacteric, or premenopausal menorrhagia or metrorrhagia.

Question 4

Rationale:

ICD-10-CM Alphabetic Index: Failure, failed  > Kidney > Acute (see also Failure, renal, acute). ICD-10-CM Alphabetic Index: Failure > Renal > Acute > With > Tubular necrosis > N17.0 (Always code to the highest specificity known. In this case, acute renal failure with ATN is more specified the Acute Renal Failure unspecified).

ICD-10-CM Alphabetic Index: Hypertrophy, hypertrophic, prostate – see Enlargement, enlarged, prostate, with lower urinary tract symptoms (LUTS).

ICD-10-CM Alphabetic Index: Enlargement, enlarged > Prostate > With > Lower urinary tract symptoms (LUTS) > N40.1.

ICD-10-CM Alphabetic Index: Obstruction, obstructed, obstructive > Urinary (moderate) > specified > N13.8.

Verify code selection in the Tabular List.

The prostate hypertrophy and urinary obstruction are coded separately in ICD-10-CM. This note is available under subcategory N40.1: Use additional code for associated symptoms, when specified: urinary obstruction (N13.8).

There is also a cross reference at code N13.8 stating to code, if applicable, any causal condition first, such as: enlarged prostate (N40.1).

Question 5

Rationale:

ICD-10-CM Alphabetic Index: Failure > Renal > Acute > N17.9

ICD-10-CM Alphabetic Index: Disease > Kidney > Chronic > Stage 4 > N18.4

ICD-10-CM Alphabetic Index: Infection > Urinary (tract) > N39.0

Verify code selection in the Tabular List. There is no combination code for acute on chronic kidney disease, so 2 codes are necessary to fully describe the condition.