D63.1 (Anemia in chronic kidney disease) compared with N18.6 (End stage renal disease), from the official CMS tabular data.
These codes can be reported together, with N18.6 sequenced before D63.1 as the tabular note instructs.
Official ruleThe conditions named and chapter.D63.1 is “Anemia in chronic kidney disease”; N18.6 is “End stage renal disease”. D63.1 sits in D50-D89 — Diseases of the Blood and Blood-forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89); N18.6 in N00-N99 — Diseases of the Genitourinary System (N00-N99).
Registry fact
Yes, in the order the notes give.N18.6 is listed before D63.1; the sequencing answer below quotes the instruction.
Official ruleGuide: Code First vs Use Additional Code vs Code Also
None.Neither entry carries an Excludes1 note that names the other code.
Official rule
None.Neither entry carries an Excludes2 note that names the other code. N18.6 carries 11 Excludes2 notes covering other codes; the side-by-side table quotes them.
Official rule
Not comparable.The codes sit in different categories; specificity is only comparable within one category.
No.Both are billable codes, and neither contains the other.
Registry fact
Yes.Sequence N18.6 before D63.1: D63.1 carries a Code First instruction covering N18.6 (“underlying chronic kidney disease (CKD) (N18.-)”).
Official ruleGuide: Code First vs Use Additional Code vs Code Also
None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.
MedCoder-derived
Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels
Yes — in the order the notes give.
No Excludes1/Excludes2 relationship exists between these codes in the official tabular list. The sequencing instruction below sets which code is listed first on the claim.
What we found
Sequence N18.6 before D63.1
D63.1 carries a Code First instruction covering N18.6: “underlying chronic kidney disease (CKD) (N18.-)”
What to review
On a claim that carries both, list N18.6 ahead of D63.1; the manifestation is never the principal diagnosis.
Why it matters
A "Code first" note means the underlying etiology is sequenced ahead of this manifestation code on the claim.
Source / rule
CMS ICD-10-CM tabular instructional notes
Section I.B.7 — Multiple coding for a single condition · applies to: Code first / Use additional code
In addition to the etiology/manifestation convention that requires two codes to fully describe a single condition that affects multiple body systems, there are other single conditions that also require more than one code. “Use additional code” notes are found in the Tabular List at codes that are not part of an etiology/manifestation pair where a secondary code is useful to fully describe a condition. The sequencing rule is the same as the etiology/manifestation pair, “use additional code” indicates that a secondary code should be added, if known. For example, for bacterial infections that are not included in chapter 1, a secondary code from category B95, Streptococcus, Staphylococcus, and Enterococcus, as the cause of diseases classified elsewhere, or B96, Other bacterial agents as the cause of diseases classified elsewhere, may be required to identify the bacterial organism causing the infection. A “use additional code” note will normally be found at the infectious disease code, indicating a need for the organism code to be added as a secondary code. “Code first” notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. When there is a “code first” note and an underlying condition is present, the underlying condition should be sequenced first, if known. […]
ICD-10-CM Official Guidelines FY2026
Section I.A.13 — Etiology/manifestation convention (“code first”, “use additional code” and “in diseases classified elsewhere” notes) · applies to: Etiology/manifestation convention
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first, if applicable, followed by the manifestation. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, “in diseases classified elsewhere.” Codes with this title are a component of the etiology/ manifestation convention. The code title indicates that it is a manifestation code. “In diseases classified elsewhere” codes are never permitted to be used as first listed or principal diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition. See category F02, Dementia in other diseases classified elsewhere, for an example of this convention. There are manifestation codes that do not have “in diseases classified elsewhere” in the title. For such codes, there is a “use additional code” note at the etiology code and a “code first” note at the manifestation code, and the rules for sequencing apply. […]
ICD-10-CM Official Guidelines FY2026
Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum
| D63.1Anemia in chronic kidney disease | N18.6End stage renal disease | |
|---|---|---|
| Billing status | Billable | Billable |
| Classification | D50-D89 — Diseases of the Blood and Blood-forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89) | N00-N99 — Diseases of the Genitourinary System (N00-N99) |
| Definition | Anemia in chronic kidney disease is a billable ICD-10-CM diagnosis code (D63.1). | End stage renal disease is a billable ICD-10-CM diagnosis code (N18.6). |
| Includes | Erythropoietin resistant anemia (EPO resistant anemia) | Chronic kidney disease requiring chronic dialysis |
| Excludes2 | — | congenital renal failure (P96.0) drug- and heavy-metal-induced tubulo-interstitial and tubular conditions (N14.-) extrarenal uremia (R39.2) hemolytic-uremic syndrome (D59.3-) hepatorenal syndrome (K76.7) postpartum hepatorenal syndrome (O90.41) posttraumatic renal failure (T79.5) prerenal uremia (R39.2) renal failure complicating abortion or ectopic or molar pregnancy (O00-O07, O08.4) renal failure following labor and delivery (O90.41) renal failure postprocedural (N99.0) |
| Code first | underlying chronic kidney disease (CKD) (N18.-) | any associated: diabetic chronic kidney disease (E08.22, E09.22, E10.22, E11.22, E13.22) |
| Use additional code | — | code to identify dialysis status (Z99.2) code, if applicable, to identify: associated cachexia (E88.A) |
Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.
Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources