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Q61.3
ICD-10-CM
Polycystic Kidney Disease

Find comprehensive information on Polycystic Kidney Disease including diagnosis codes, clinical documentation requirements, ICD-10 codes for PKD, medical coding guidelines, healthcare provider resources, renal disease management, and PKD treatment options. Learn about symptoms, genetic testing, and the latest research on Polycystic Kidney Disease for accurate clinical documentation and appropriate medical billing.

Also known as

PKD
Autosomal Dominant Polycystic Kidney Disease
ADPKD
+2 more

Diagnosis Snapshot

Key Facts
  • Definition : Genetic disorder forming cysts in the kidneys, reducing function over time.
  • Clinical Signs : High blood pressure, back or flank pain, headaches, frequent urination, blood in urine.
  • Common Settings : Nephrology clinics, dialysis centers, transplant centers, primary care physician offices.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC Q61.3 Coding
Q61

Cystic kidney disease

Covers various cystic kidney disorders, including polycystic kidney disease.

N60-N64

Diseases of the breast

Includes codes related to kidney and ureter infections that can sometimes be associated with PKD complications.

I10-I15

Hypertensive diseases

High blood pressure, a common complication of polycystic kidney disease.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the polycystic kidney disease acquired?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Polycystic kidney disease
Medullary sponge kidney
Acquired cystic kidney disease

Documentation Best Practices

Documentation Checklist
  • Document family history of PKD (autosomal dominant/recessive)
  • Imaging evidence: Ultrasound, CT, MRI findings of cysts
  • Genetic testing results confirming PKD1 or PKD2 mutations
  • Clinical symptoms: pain, hypertension, hematuria, kidney function
  • Size and number of kidney cysts documented by imaging studies

Coding and Audit Risks

Common Risks
  • Laterality Coding

    Missing or incorrect laterality coding (right, left, bilateral) for cysts and related procedures impacting reimbursement and data accuracy. ICD-10-CM coding guidelines crucial for PKD.

  • Specificity of PKD

    Failing to differentiate between autosomal dominant (ADPKD) and autosomal recessive (ARPKD) forms using specific ICD-10-CM codes leads to inaccurate reporting and analysis. CDI query opportunity.

  • Manifestation Coding

    Incomplete capture of associated manifestations like hypertension and renal failure complicates severity assessment and HCC risk adjustment. Impacts quality reporting and MS-DRG assignment.

Mitigation Tips

Best Practices
  • Control hypertension: ICD-10 I12.9, I15.9; CPT 99213-99215
  • Manage pain: SNOMED CT 22554001; ICD-10 N28.89; CPT 99202-99205
  • Address cyst infections: ICD-10 N13.30; CPT 59025
  • Monitor kidney function: ICD-10 N18.4; CPT 82570, 82950, 82951
  • Genetic counseling: ICD-10 Q61.5; CPT 96040

Clinical Decision Support

Checklist
  • 1. Family hx of PKD (ICD-10: Q61.0)? Document pedigree.
  • 2. Imaging: Multiple kidney cysts (ICD-10: N28.8)? Report size/location.
  • 3. Hypertension (ICD-10: I10)? Evaluate/document BP control.
  • 4. Elevated creatinine (ICD-10: N18)? Stage chronic kidney disease.

Reimbursement and Quality Metrics

Impact Summary
  • Polycystic Kidney Disease reimbursement hinges on accurate ICD-10-CM coding (Q61.-) and appropriate documentation of severity, laterality, and manifestations for optimal payer specificity.
  • Quality metrics for PKD include tracking disease progression (eGFR, total kidney volume), blood pressure control, and management of complications (infection, pain) impacting hospital reporting.
  • Coding errors (e.g., unspecified vs. specified PKD type) can lead to claim denials, impacting revenue cycle management and accurate reflection of disease burden.
  • Precise documentation and coding facilitate risk adjustment models and appropriate resource allocation for PKD patients, enhancing quality of care and financial outcomes.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code primary PKD type (ADPKD/ARPKD)
  • Document manifestation specifics
  • Link hypertension to PKD if present
  • Code CKD stage with PKD
  • Consider laterality codes for cysts

Documentation Templates

Patient presents with complaints consistent with polycystic kidney disease (PKD) symptoms, including flank pain, abdominal fullness, hematuria, and hypertension.  Family history is positive for autosomal dominant polycystic kidney disease (ADPKD).  Physical examination reveals palpable bilateral kidney enlargement.  Ultrasound imaging demonstrates multiple renal cysts, confirming the diagnosis of PKD.  Differential diagnosis included simple renal cysts, acquired cystic kidney disease, and multicystic dysplastic kidney.  Assessment supports a diagnosis of autosomal dominant polycystic kidney disease.  Plan includes monitoring of blood pressure, renal function (eGFR, creatinine), and electrolyte levels.  Patient education provided on PKD management, including dietary modifications (low sodium, fluid management), pain management strategies, and blood pressure control.  Genetic counseling referral recommended.  Follow-up scheduled to monitor disease progression and assess for complications such as kidney stones, urinary tract infections, and intracranial aneurysms.  ICD-10 code Q61.0 (autosomal dominant polycystic kidney disease) is documented for medical billing and coding purposes.  Patient understands the chronic nature of PKD and the importance of regular monitoring.