N18.4
BillableChronic kidney disease, stage 4 (severe)
HCC Category Mapping
V28HCC 327 — Chronic Kidney Disease, Stage 4 (Severe)
0.000V24HCC 137 — Chronic Kidney Disease, Severe (Stage 4)
0.289ESRDHCC 137 — Chronic Kidney Disease, Severe (Stage 4)
0.000RxHCCHCC 263 — Chronic Kidney Disease, Stage 4
0.000What This Code Means
Stage 4 chronic kidney disease where kidney function is severely decreased with a GFR of 15-29, indicating the kidneys are functioning at only 15-29% of normal capacity.
Coding Tips
- •Verify GFR range of 15-29 mL/min/1.73m² is documented; patients at this stage typically require nephrology referral and dialysis planning
- •Document comorbidities and complications such as anemia, bone disease, and hypertension that commonly accompany stage 4 CKD
Clinical Significance
Stage 4 chronic kidney disease represents severe kidney dysfunction (GFR 15-29) requiring active preparation for renal replacement therapy and intensive management of complications. This diagnosis indicates advanced CKD with significant morbidity and healthcare resource utilization requiring specialized nephrology care.
Documentation Requirements
- ✓Chronic kidney disease stage 4 clearly documented
- ✓GFR values in the 15-29 range supporting stage 4 classification
- ✓Active nephrology management and renal replacement therapy planning
- ✓Assessment and management of CKD-related complications
- ✓Cardiovascular risk management and monitoring
- ✓Patient education regarding dialysis and transplant options
- ✓Laboratory monitoring for CKD-mineral bone disorder and anemia
Commonly Confused Codes
Code Hierarchy
└N18Chronic kidney disease (CKD)└N18.4Chronic kidney disease, stage 4 (severe)
└N18.4Chronic kidney disease, stage 4 (severe)