Question 1

What is ICD-10 code N01.2?

Accepted Answer

N01.2 is the ICD-10-CM diagnosis code for rapidly progressive nephritic syndrome with diffuse membranous glomerulonephritis. A rapidly progressive kidney disease where the filtering membranes thicken uniformly throughout the kidney, leading to protein loss and kidney function decline. N01.2 sits in the ICD-10-CM chapter for diseases of the genitourinary system (n00-n99), within the section covering glomerular diseases (n00-n08).

N01.2 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28, V24, ESRD, or RxHCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Diffuse membranous pattern requires kidney biopsy confirmation; document the biopsy findings in the medical record.

Question 2

Is N01.2 an HCC code?

Accepted Answer

No. N01.2 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is N01.2 billable?

Accepted Answer

Yes. N01.2 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. N01.2 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

Which HCC does N01.2 map to under V28?

Accepted Answer

N01.2 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What RAF reference is published for N01.2?

Accepted Answer

N01.2 has no separately stated V28 community reference coefficient. Check the current CMS mapping and factor files before using it in any member-score workflow.

Question 6

What is the V28 vs V24 difference for N01.2?

Accepted Answer

N01.2 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards N01.2 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 7

What documentation supports N01.2?

Accepted Answer

Diffuse membranous pattern requires kidney biopsy confirmation; document the biopsy findings in the medical record Distinguish from primary membranous nephropathy by confirming the rapidly progressive clinical course N01.2 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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N01.2

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N01.2 ICD-10-CM Code: Rapidly progressive nephritic syndrome with diffuse membranous glomerulonephritis

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N01.2

Is N01.2 an HCC code?

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Child Codes

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