N04.9 ICD-10-CM Code: Nephrotic syndrome with unspecified morphologic changes

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for N04.9 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on N04.9 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for N04.9

MedCoder structured workflow — derived from this code’s own official record

Before you code N04.9

1. Unspecified does not mean incorrect. When the record gives no greater specificity, N04.9 may be the appropriate code. Check the record for detail that supports a more specific sibling — in this subcategory the siblings differ by the presence or absence of the associated condition. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

   ReviewN04.0, N04.1, N04.2, N04.3, N04.4, N04.5, N04.6, N04.7

   See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

2. N04.9’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

   Guide: Combination codes →

3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with N04.9. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

   See the official tabular notes

Choose the right path

1. Does the record document the detail a more specific sibling code needs?
   Yes → Review the specific siblings in this subcategory.
   No → Continue — N04.9 is appropriate when the documentation goes no further.

   ReviewN04.0, N04.1, N04.2, N04.3, N04.4, N04.5, N04.6, N04.7

2. Does the documentation support a condition named in N04.9’s Excludes1 note?
   Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
   No → Continue.

   ReviewI12

Consider N04.9. Then review the Code Also note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

The associated condition or complication

Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).

Any detail beyond this code’s title

What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

• Excludes1 — check before selecting N04.9(1 note)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with N04.9: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareI12

  See the official tabular notes · Guidelines I.A.12.a

• Code Also — related condition(1 note)

  Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

  See the official tabular notes · Guidelines I.A.17

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Indexed Clinical Terms (12)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Anasarca, renal
• Disease, diseased, foot process
• Lipoid, nephrosis
• Nephritis, nephritic (albuminuric) (azotemic) (congenital) (disseminated) (epithelial) (familial) (focal) (granulomatous) (hemorrhagic) (infantile) (nonsuppurative, excretory) (uremic), with, foot process disease
• Nephrosis, nephrotic (Epstein's) (syndrome) (congenital)
• Nephrosis, nephrotic (Epstein's) (syndrome) (congenital), acute
• Nephrosis, nephrotic (Epstein's) (syndrome) (congenital), lipoid
• Nephrosis, nephrotic (Epstein's) (syndrome) (congenital), radiation
• Nephrosis, nephrotic (Epstein's) (syndrome) (congenital), tubular (acute), radiation
• Nephrosis, nephrotic (Epstein's) (syndrome) (congenital), with, foot process disease
• Syndrome, idiopathic, nephrotic (infantile)
• Syndrome, nephrotic (congenital)

Don’t confuse N04.9 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of N04.9 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• I12— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of hypertensive chronic kidney disease moves the case to I12; the two are not reported together unless documented as unrelated.

  Full comparison: N04.9 vs I12 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name N04.9 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: Q63 — Other congenital malformations of kidney (via N04.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 286 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 698 (MDC 11), DRG 699 (MDC 11), DRG 700 (MDC 11).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):GEN001 — Nephritis; nephrosis; renal sclerosis (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

N04.20 — Nephrotic syndrome with diffuse membranous glomerulonephritis, unspecified, N04.21 — Primary membranous nephropathy with nephrotic syndrome, N04.22 — Secondary membranous nephropathy with nephrotic syndrome, N04.29 — Other nephrotic syndrome with diffuse membranous glomerulonephritis, N04.3 — Nephrotic syndrome with diffuse mesangial proliferative glomerulonephritis, N04.4 — Nephrotic syndrome with diffuse endocapillary proliferative glomerulonephritis, N04.5 — Nephrotic syndrome with diffuse mesangiocapillary glomerulonephritis, N04.6 — Nephrotic syndrome with dense deposit disease, N04.7 — Nephrotic syndrome with diffuse crescentic glomerulonephritis, N04.8 — Nephrotic syndrome with other morphologic changes, N04.A — Nephrotic syndrome with C3 glomerulonephritis, N04.B1 — Nephrotic syndrome with idiopathic immune complex membranoproliferative glomerulonephritis (IC-MPGN), N04.B2 — Nephrotic syndrome with secondary immune complex membranoproliferative glomerulonephritis (IC-MPGN), N05.0 — Unspecified nephritic syndrome with minor glomerular abnormality, N05.1 — Unspecified nephritic syndrome with focal and segmental glomerular lesions, N05.2 — Unspecified nephritic syndrome with diffuse membranous glomerulonephritis, N05.3 — Unspecified nephritic syndrome with diffuse mesangial proliferative glomerulonephritis, N05.4 — Unspecified nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis, N05.5 — Unspecified nephritic syndrome with diffuse mesangiocapillary glomerulonephritis, N05.6 — Unspecified nephritic syndrome with dense deposit disease, +265 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Nephritis; nephrosis; renal sclerosis).

N04.20 — Nephrotic syndrome with diffuse membranous glomerulonephritis, unspecified, N04.21 — Primary membranous nephropathy with nephrotic syndrome, N04.22 — Secondary membranous nephropathy with nephrotic syndrome, N04.29 — Other nephrotic syndrome with diffuse membranous glomerulonephritis, N04.3 — Nephrotic syndrome with diffuse mesangial proliferative glomerulonephritis, N04.4 — Nephrotic syndrome with diffuse endocapillary proliferative glomerulonephritis, N04.5 — Nephrotic syndrome with diffuse mesangiocapillary glomerulonephritis, N04.6 — Nephrotic syndrome with dense deposit disease, N04.7 — Nephrotic syndrome with diffuse crescentic glomerulonephritis, N04.8 — Nephrotic syndrome with other morphologic changes, N04.A — Nephrotic syndrome with C3 glomerulonephritis, N04.B1 — Nephrotic syndrome with idiopathic immune complex membranoproliferative glomerulonephritis (IC-MPGN), N04.B2 — Nephrotic syndrome with secondary immune complex membranoproliferative glomerulonephritis (IC-MPGN), N05.0 — Unspecified nephritic syndrome with minor glomerular abnormality, N05.1 — Unspecified nephritic syndrome with focal and segmental glomerular lesions, N05.2 — Unspecified nephritic syndrome with diffuse membranous glomerulonephritis, N05.3 — Unspecified nephritic syndrome with diffuse mesangial proliferative glomerulonephritis, N05.4 — Unspecified nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis, N05.5 — Unspecified nephritic syndrome with diffuse mesangiocapillary glomerulonephritis, N05.6 — Unspecified nephritic syndrome with dense deposit disease, +112 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Nephritis, nephritic”, “Nephrosis, nephrotic”; these codes share that main term but sit in a different category of the Tabular List.

N03.1 — Chronic nephritic syndrome with focal and segmental glomerular lesions (chronic, with, focal and segmental glomerular lesions), N03.2 — Chronic nephritic syndrome with diffuse membranous glomerulonephritis (chronic, with, diffuse, membranous glomerulonephritis), N03.3 — Chronic nephritic syndrome with diffuse mesangial proliferative glomerulonephritis (chronic, with, diffuse, mesangial proliferative glomerulonephritis), N03.4 — Chronic nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis (chronic, with, diffuse, endocapillary proliferative glomerulonephritis), N03.5 — Chronic nephritic syndrome with diffuse mesangiocapillary glomerulonephritis (chronic, with, diffuse, mesangiocapillary glomerulonephritis), N03.6 — Chronic nephritic syndrome with dense deposit disease (chronic, with, dense deposit disease), N03.7 — Chronic nephritic syndrome with diffuse crescentic glomerulonephritis (chronic, with, diffuse, crescentic glomerulonephritis), N03.8 — Chronic nephritic syndrome with other morphologic changes (chronic, with, specified morphological changes NEC), N03.9 — Chronic nephritic syndrome with unspecified morphologic changes (chronic), N03.A — Chronic nephritic syndrome with C3 glomerulonephritis (chronic, with, C3, glomerulopathy), N05.0 — Unspecified nephritic syndrome with minor glomerular abnormality (minimal change), N05.1 — Unspecified nephritic syndrome with focal and segmental glomerular lesions (with, focal and segmental glomerular lesions), N05.2 — Unspecified nephritic syndrome with diffuse membranous glomerulonephritis (with, diffuse, membranous glomerulonephritis), N05.3 — Unspecified nephritic syndrome with diffuse mesangial proliferative glomerulonephritis (with, diffuse, mesangial proliferative glomerulonephritis), N05.4 — Unspecified nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis (with, diffuse, endocapillary proliferative glomerulonephritis), N05.5 — Unspecified nephritic syndrome with diffuse mesangiocapillary glomerulonephritis (membranoproliferative), N05.6 — Unspecified nephritic syndrome with dense deposit disease (with, dense deposit disease), N05.7 — Unspecified nephritic syndrome with diffuse crescentic glomerulonephritis (with, diffuse, crescentic glomerulonephritis), N05.8 — Unspecified nephritic syndrome with other morphologic changes (proliferative NEC), N05.9 — Unspecified nephritic syndrome with unspecified morphologic changes, +68 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Gamma-glutamyl Transferase (GGT) Test, Iron Panel, Lipid Panel, Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of N04.9 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run N04.9 with this related code in Claim Check

Hierarchy

• N00-N99 — Chapter 14: Diseases of the Genitourinary System (N00-N99) (N00-N99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N00-N08 — Glomerular diseases[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• Q63 — Other congenital malformations of kidney[Excludes1](via N04.-): “congenital nephrotic syndrome (N04.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• GEN001 — Nephritis; nephrosis; renal sclerosis[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
• DRG 698 — OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC[MS-DRG]: “OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC (MDC 11)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 699 — OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC[MS-DRG]: “OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC (MDC 11)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 700 — OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC[MS-DRG]: “OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC (MDC 11)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 11 — Diseases and Disorders of the Kidney and Urinary Tract[MDC crossing]: “Diseases and Disorders of the Kidney and Urinary Tract — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 3,574 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries (12)

• Anasarca, renal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Disease, diseased, foot process[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Lipoid, nephrosis[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Nephritis, nephritic (albuminuric) (azotemic) (congenital) (disseminated) (epithelial) (familial) (focal) (granulomatous) (hemorrhagic) (infantile) (nonsuppurative, excretory) (uremic), with, foot process disease[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Nephrosis, nephrotic (Epstein's) (syndrome) (congenital)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Nephrosis, nephrotic (Epstein's) (syndrome) (congenital), acute[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Nephrosis, nephrotic (Epstein's) (syndrome) (congenital), lipoid[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Nephrosis, nephrotic (Epstein's) (syndrome) (congenital), radiation[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• and 4 more

Nearest codes (18)

• N04 — Nephrotic syndrome[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N04.0 — Nephrotic syndrome with minor glomerular abnormality[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N04.1 — Nephrotic syndrome with focal and segmental glomerular lesions[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N04.2 — Nephrotic syndrome with diffuse membranous glomerulonephritis[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N04.20 — Nephrotic syndrome with diffuse membranous glomerulonephritis, unspecified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N04.21 — Primary membranous nephropathy with nephrotic syndrome[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N04.22 — Secondary membranous nephropathy with nephrotic syndrome[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N04.29 — Other nephrotic syndrome with diffuse membranous glomerulonephritis[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 10 more

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to N04.9 in its code family, with their registry titles.

• N04.3 — Nephrotic syndrome with diffuse mesangial proliferative glomerulonephritis
• N04.4 — Nephrotic syndrome with diffuse endocapillary proliferative glomerulonephritis
• N04.5 — Nephrotic syndrome with diffuse mesangiocapillary glomerulonephritis
• N04.6 — Nephrotic syndrome with dense deposit disease
• N04.7 — Nephrotic syndrome with diffuse crescentic glomerulonephritis
• N04.8 — Nephrotic syndrome with other morphologic changes
• N04.A — Nephrotic syndrome with C3 glomerulonephritis
• N04.B — Nephrotic syndrome with immune complex membranoproliferative glomerulonephritis (IC-MPGN)
• N04.B1 — Nephrotic syndrome with idiopathic immune complex membranoproliferative glomerulonephritis (IC-MPGN)
• N04.B2 — Nephrotic syndrome with secondary immune complex membranoproliferative glomerulonephritis (IC-MPGN)

View all codes in the N04 family