N18.5
BillableChronic kidney disease, stage 5
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is N18.5 an HCC code?
Yes. N18.5 maps to Chronic Kidney Disease, Stage 5/End Stage Renal Disease under the CMS-HCC V28 risk adjustment model (and Chronic Kidney Disease, Stage 5 under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for N18.5
For N18.5 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed N18.5 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
N18.5 is the ICD-10-CM diagnosis code for chronic kidney disease, stage 5. Stage 5 chronic kidney disease (end-stage renal disease) where kidney function is severely compromised with a GFR less than 15, requiring dialysis or kidney transplant. N18.5 sits in the ICD-10-CM chapter for diseases of the genitourinary system (n00-n99), within the section covering acute kidney failure and chronic kidney disease (n17-n19).
Under the CMS-HCC V28 risk adjustment model, N18.5 maps to Chronic Kidney Disease, Stage 5/End Stage Renal Disease (HCC 326) with a community, non-dual, aged base RAF weight of 0.451. Under the older CMS-HCC V24 model, N18.5 maps to Chronic Kidney Disease, Stage 5 (HCC 136) with a community, non-dual, aged base RAF weight of 0.289. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Confirm GFR is less than 15 mL/min/1.73m² or that the patient is on dialysis or has received a kidney transplant. Because N18.5 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for N18.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm GFR is less than 15 mL/min/1.73m² or that the patient is on dialysis or has received a kidney transplant
- •Code dialysis status separately (Z99.2 for dependence on dialysis) and document transplant status if applicable; also code related complications
Clinical Significance
Stage 5 chronic kidney disease represents kidney failure (GFR <15) requiring renal replacement therapy or preparation for dialysis/transplant. This diagnosis indicates end-stage kidney disease with significant morbidity, mortality risk, and high healthcare resource utilization requiring specialized nephrology management.
Documentation Requirements
- ✓Chronic kidney disease stage 5 clearly documented
- ✓GFR less than 15 or patient on dialysis
- ✓Active renal replacement therapy or preparation documented
- ✓Management of stage 5 CKD complications
- ✓Nephrology management and treatment plan
- ✓Assessment for transplant candidacy if appropriate
- ✓Documentation of dialysis type and schedule if applicable
Excludes 1 — Do NOT code together
- chronic kidney disease, stage 5 requiring chronic dialysis (N18.6)