N18.6 ICD-10-CM Code: End stage renal disease

Code

N18.6

Description

End stage renal disease

HCC (V28)

HCC 326 — Chronic Kidney Disease, Stage 5

RAF reference coefficient

0.815

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work N18.6 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for N18.6

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for N18.6 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Documentation must establish end-stage renal disease with chronic dialysis dependence. Always pair with Z99.2 (dependence on renal dialysis) per ICD-10-CM 'code also' convention, this is one of the most commonly missed pairings.
• •Do not use N18.6 for acute kidney injury requiring temporary dialysis, that is N17.x with Z99.2. ESRD is a chronic, irreversible loss of function and must be charted as such.
• •For dialysis-dependent patients, ensure Z99.2 is captured on the claim, while Z99.2 itself is not an HCC, its absence on an ESRD claim is a documentation red flag in audit.

Clinical Significance

End stage renal disease represents complete kidney failure requiring dialysis or transplantation for survival, indicating the most severe form of chronic kidney disease. This diagnosis carries significant morbidity, mortality, and healthcare resource utilization requiring comprehensive multidisciplinary management.

Documentation Requirements

• ✓End stage renal disease clearly documented
• ✓Evidence of complete or near-complete kidney failure
• ✓Current renal replacement therapy (dialysis or transplant) documented
• ✓Management of ESRD-related complications
• ✓Multidisciplinary care team involvement
• ✓Assessment of transplant status or candidacy
• ✓Documentation of dialysis adequacy and complications if applicable

Commonly Confused Codes

• •N18.5: Chronic kidney disease, stage 5 (essentially equivalent condition)
• •Z99.2: Dependence on renal dialysis (status code, not disease code)
• •Z94.0: Kidney transplant status (status code for post-transplant patients)
• •N19: Unspecified kidney failure (when ESRD is clearly established)

Child Codes