End-Stage Renal Disease (ESRD), also known as kidney failure, is a severe condition where the kidneys lose their ability to function effectively. In medical diagnosis and billing, accurate coding is crucial. This article delves into the specifics of the Diagnosis Code For Esrd, focusing on the ICD-10-CM code N18.6. Understanding this code is vital for healthcare professionals, medical coders, and anyone involved in the medical or automotive field where patient transportation and medical emergencies are concerned.
Understanding ICD-10-CM Code N18.6 for End Stage Renal Disease
ICD-10-CM code N18.6 is the designated code for End Stage Renal Disease within the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). This code is specifically used for diagnoses made in the United States, with the 2025 edition becoming effective on October 1, 2024. It’s important to note that international versions of ICD-10 may have variations of this code.
N18.6 is classified as a billable/specific code, meaning it is precise enough to be used for reimbursement purposes. This is crucial for medical billing and insurance claims related to ESRD.
Applicable Conditions for N18.6
The code N18.6 is specifically applicable to conditions where chronic kidney disease requires chronic dialysis. This highlights a key aspect of ESRD coding: it often signifies the stage where kidney function is so severely diminished that dialysis is necessary to sustain life.
“Use Additional Code” Convention
In ICD-10-CM, certain conditions have both an underlying cause (etiology) and manifestations in various body systems. For these cases, a specific coding convention is applied. This involves a “use additional code” note at the etiology code and a “code first” note at the manifestation code. This system ensures that the underlying condition is listed first, followed by its manifestations.
Codes that are manifestations are often identified in their title as “in diseases classified elsewhere.” These codes should never be used as the primary diagnosis; they must always be accompanied by and listed after the underlying condition code. While N18.6 itself does not have a “code first” note directly associated with it, understanding this convention is crucial for accurate coding in complex cases involving ESRD and related conditions.
Annotations and Back-References Related to N18.6
Annotation back-references in the ICD-10-CM system point to codes that contain various annotations relevant to N18.6. These annotations can include:
- Applicable To annotations
- Code Also annotations
- Code First annotations
- Excludes1 annotations
- Excludes2 annotations
- Includes annotations
- Note annotations
- Use Additional annotations
These annotations provide further guidance and context when using the N18.6 code, ensuring accurate and comprehensive coding.
Approximate Synonyms for End Stage Renal Disease (N18.6)
To ensure clarity and assist in diagnosis coding, several approximate synonyms are associated with N18.6. These terms represent different clinical scenarios and ways ESRD might be documented:
- Anemia due to end stage renal disease
- Anemia in end stage renal disease
- Anemia, end stage renal disease
- Benign hypertensive heart and chronic kidney disease (CKD), ESRD, with congestive heart failure (CHF)
- Benign hypertensive heart and end stage renal disease
- Benign hypertensive heart and end stage renal disease with congestive heart failure
- Chronic kidney disease
- Chronic kidney disease due to type 2 diabetes mellitus with hyperparathyroidism due to end stage renal disease on dialysis
- Chronic kidney disease on hemodialysis
- Chronic kidney disease with end stage renal disease on dialysis due to drug induced diabetes mellitus
- Chronic kidney disease with end stage renal disease on dialysis due to secondary diabetes mellitus
- Chronic kidney disease with end stage renal disease on dialysis due to type 1 diabetes mellitus
- Chronic kidney disease with end stage renal disease on dialysis due to type 2 diabetes mellitus
- Chronic kidney disease, ESRD due to benign hypertension
- Chronic kidney failure with hypertension
- Dependence on continuous ambulatory peritoneal dialysis due to end stage renal disease
- Dependence on continuous cyclic peritoneal dialysis due to end stage renal disease
- Dependence on dialysis due to end stage renal disease
- Dependence on hemodialysis due to end stage renal disease
- Dependence on peritoneal dialysis due to end stage renal disease
- Diabetes 1 with end stage renal disease on dialysis
- Diabetes 2 with end stage renal disease on dialysis
- Diabetes type 1 on dialysis
- Diabetes type 2 on dialysis
- Diabetes Mellitus 2 with diabetic chronic kidney disease, secondary hyperparathyroidism due to ESRD, on dialysis
- Drug induced diabetes chronic kidney disease, dialysis
- End stage renal disease due to hypertension
- End stage renal disease due to hypertension, on dialysis
- End stage renal disease on dialysis
- End stage renal disease on dialysis due to hypertension
- End stage renal disease on dialysis due to type 2 diabetes mellitus
- End stage renal disease on peritoneal dialysis
- ESRD on continuous ambulatory peritoneal dialysis
- ESRD on continuous cyclic peritoneal dialysis
- Hyperparathyroidism due to end stage renal disease on dialysis
- Hypertension concurrent and due to end stage renal disease on dialysis due to type 2 diabetes mellitus
- Hypertension in chronic kidney disease with end stage renal disease on dialysis due to type 1 diabetes mellitus
- Hypertension in chronic kidney disease with end stage renal disease on dialysis due to type 2 diabetes mellitus
- Hypertensive chronic kidney disease on dialysis
- Hypertensive chronic kidney disease with dialysis
- Hypertensive chronic kidney disease, severe
- Hypertensive heart and chronic kidney disease on dialysis
- Hypertensive heart and chronic kidney disease on dialysis with congestive heart failure
- Hypertensive heart and kidney disease
- Hypertensive heart disease, kidney disease
- Hypertensive kidney and heart disease, on dialysis
- Malignant hypertension chronic kidney disease with ESRD on dialysis
- Malignant hypertensive end stage renal disease
- Malignant hypertensive end stage renal disease on dialysis
- Malignant hypertensive heart and end stage renal disease with congestive heart failure
- Secondary diabetes, chronic kidney disease on dialysis
- Secondary hyperparathyroidism due to ESRD, on dialysis
- Severe chronic kidney failure with hypertension
- Severe chronic kidney failure with hypertension (HTN) on dialysis
This extensive list demonstrates the wide range of clinical presentations and associated conditions that can lead to a diagnosis coded as N18.6.
Clinical Context of End Stage Renal Disease
Clinically, End Stage Renal Disease is characterized by:
- Chronic, irreversible renal failure: The damage to the kidneys is permanent and cannot be reversed.
- Long-standing and persistent renal disease: ESRD develops over time due to chronic kidney disease.
- Glomerular Filtration Rate (GFR) less than 15 ml/min: GFR is a key indicator of kidney function. A GFR below 15 ml/min signifies severe kidney damage consistent with ESRD.
Patients with ESRD require dialysis or kidney transplantation to survive due to the inability of their kidneys to filter waste and excess fluid from the blood.
Code History of N18.6
The ICD-10-CM code N18.6 for End Stage Renal Disease is a relatively recent addition to the coding system:
- 2016: N18.6 was introduced as a new code, marking the first year of the non-draft ICD-10-CM.
- 2017-2025: No changes have been made to the code since its introduction, indicating its established and consistent use in medical coding.
This stable code history is important for long-term data analysis and tracking of ESRD prevalence and related healthcare trends.
ICD-10-CM Codes Adjacent to N18.6
Understanding the codes surrounding N18.6 provides further context within the ICD-10-CM classification system. Codes adjacent to N18.6 include:
- N17.9: Acute kidney failure, unspecified
- N18: Chronic kidney disease (CKD) (This is the parent category for N18.6)
- N18.1 – N18.5: Stages 1 through 5 of chronic kidney disease (Stages leading up to ESRD/Stage 5)
- N18.9: Chronic kidney disease, unspecified
- N19: Unspecified kidney failure
- N20 – N21.1: Codes related to calculus of kidney, ureter, and lower urinary tract (Conditions that can sometimes be related to or co-occur with kidney disease).
These adjacent codes highlight the spectrum of kidney diseases and failures, placing N18.6 specifically at the severe end of chronic kidney disease.
Conclusion
The diagnosis code N18.6 is the standard identifier for End Stage Renal Disease in the ICD-10-CM coding system. Its specific application to chronic kidney disease requiring dialysis, along with its associated synonyms and clinical context, makes it a critical code for accurate medical documentation, billing, and epidemiological tracking of this serious condition. For professionals in both the medical and automotive industries who may encounter situations involving patient care and transportation, a foundational understanding of codes like N18.6 is invaluable.
Reimbursement claims with a date of service on or after October 1, 2015, require the use of ICD-10-CM codes.
