What is ICD-10 code N28.0?

N28.0 is the ICD-10-CM diagnosis code for Ischemia and infarction of kidney. Reduced blood flow to the kidney or death of kidney tissue due to blocked blood vessels, which can cause sudden loss of kidney function. N28.0 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. N28.0 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. N28.0 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. N28.0 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.

Which HCC does N28.0 map to under V28?

N28.0 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.

What does N28.0 pay in RAF?

N28.0 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

What is the V28 vs V24 difference for N28.0?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. N28.0 was a payment HCC under V24 (Vascular Disease with Complications) but the V28 recalibration removed it from the risk adjustment model. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports N28.0?

Document the cause of ischemia (thrombosis, embolism, stenosis) when available for more complete coding Distinguish between acute infarction and chronic ischemic changes based on clinical presentation and timing Because N28.0 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM N28.0: Ischemia and infarction

N28.0 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupN28.0Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the genitourinary system (N00-N99) / Other disorders of kidney and ureter (N25-N29)

N28.0

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Ischemia and infarction of kidney

Reduced blood flow to the kidney or death of kidney tissue due to blocked blood vessels, which can cause sudden loss of kidney function.

Buddy Insight

Renal ischemia and infarction represents acute vascular compromise that can lead to permanent kidney damage and chronic kidney disease.

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Mapped

HCC 107

Vascular Disease with Complic...

RAF 0.383

ACA/HHS

Mapped

HCC 154

HHS-HCC 154

Varies by metal level

ESRD/PACE

Mapped

HCC 107

Vascular Disease with Complic...

RAF 0.144

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

N28Other disorders of kidney and ureter, not elsewhere classified

N28.0Ischemia and infarction of kidney

Inclusion Terms

Official

Renal artery embolism
Renal artery obstruction
Renal artery occlusion
Renal artery thrombosis
Renal infarct

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for N28.0 in this effective period.

Related Child Codes

Official

N28.1Cyst of kidney, acquired

N28.8Other specified disorders of kidney and ureter

N28.9Disorder of kidney and ureter, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for N28.0 in this effective period.

Excludes 1

Official

atherosclerosis of renal artery (extrarenal part) (I70.1)
congenital stenosis of renal artery (Q27.1)
Goldblatt's kidney (I70.1)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for N28.0 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for N28.0 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for N28.0 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Evidence of acute or chronic renal artery occlusion

Imaging confirmation of renal infarction or ischemia

Laboratory evidence of acute kidney injury or dysfunction

Documentation of underlying vascular disease or embolic source

MEAT Support

HCC Buddy guidance

Evidence of acute or chronic renal artery occlusion

Imaging confirmation of renal infarction or ischemia

Laboratory evidence of acute kidney injury or dysfunction

Documentation of underlying vascular disease or embolic source

Audit Caution

HCC Buddy guidance

Confusing chronic renal artery stenosis with acute infarction

Failing to document the vascular etiology of kidney dysfunction

Missing the acute vs chronic nature of the ischemic event

Not distinguishing from functional acute kidney injury

Common Mistakes

HCC Buddy guidance

N17.9 — Acute kidney injury, unspecified (functional AKI without vascular cause)

I70.1 — Atherosclerosis of renal artery (chronic stenosis without infarction)

N26.1 — Atrophy of kidney (chronic result, not acute ischemic event)

N18.6 — End stage renal disease (chronic condition, not acute vascular event)

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is N28.0 an HCC code?

Yes. N28.0 maps to Vascular Disease with Complications under the V24 model but is not retained in V28.

Code: N28.0
Description: Ischemia and infarction of kidney
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

V24HCC 107, Vascular Disease with Complications

0.383

ESRDHCC 107, Vascular Disease with Complications

0.144

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work N28.0 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for N28.0

For N28.0 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 N28.0 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

N28.0 is the ICD-10-CM diagnosis code for ischemia and infarction of kidney. Reduced blood flow to the kidney or death of kidney tissue due to blocked blood vessels, which can cause sudden loss of kidney function. N28.0 sits in the ICD-10-CM chapter for diseases of the genitourinary system (n00-n99), within the section covering other disorders of kidney and ureter (n25-n29).

Under the older CMS-HCC V24 model, N28.0 maps to Vascular Disease with Complications (HCC 107) with a community, non-dual, aged base RAF weight of 0.383. 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.

Document the cause of ischemia (thrombosis, embolism, stenosis) when available for more complete coding. Because N28.0 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 N28.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the cause of ischemia (thrombosis, embolism, stenosis) when available for more complete coding
•Distinguish between acute infarction and chronic ischemic changes based on clinical presentation and timing

Clinical Significance

Renal ischemia and infarction represents acute vascular compromise that can lead to permanent kidney damage and chronic kidney disease. This condition requires immediate intervention and carries significant morbidity risk, making it important for risk stratification and care planning.

Documentation Requirements

✓Evidence of acute or chronic renal artery occlusion
✓Imaging confirmation of renal infarction or ischemia
✓Laboratory evidence of acute kidney injury or dysfunction
✓Documentation of underlying vascular disease or embolic source
✓Assessment of bilateral vs unilateral involvement
✓Exclusion of other causes of acute kidney injury
✓Clinical presentation consistent with renal infarction
✓Treatment plan addressing vascular compromise

Excludes 1, Do NOT code together

atherosclerosis of renal artery (extrarenal part) (I70.1)
congenital stenosis of renal artery (Q27.1)
Goldblatt's kidney (I70.1)

Commonly Confused Codes

•N17.9: Acute kidney injury, unspecified (functional AKI without vascular cause)
•I70.1: Atherosclerosis of renal artery (chronic stenosis without infarction)
•N26.1: Atrophy of kidney (chronic result, not acute ischemic event)
•N18.6: End stage renal disease (chronic condition, not acute vascular event)
•I15.0: Renovascular hypertension (hypertension focus, not infarction)