ICD-10 N04.20
Billable / Specific CCNephrotic syndrome with diffuse membranous glomerulonephritis, unspecified
About ICD-10-CM N04.20
ICD-10-CM code N04.20 represents Nephrotic syndrome with diffuse membranous glomerulonephritis, unspecified. This is a billable/specific code in the Genitourinary System chapter (block N04). The 2026 edition of ICD-10-CM N04.20 became effective on October 1, 2025.
Coding Tips for N04.20
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
N04.20 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under N04.20. Per CMS ICD-10-CM Tabular 2026.
- Membranous nephropathy NOS with nephrotic syndrome
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Nephrotic syndrome with diffuse membranous glomerulonephritis, unspecified. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for N04.20
Local Coverage Determinations (LCDs) from CMS MACs that list N04.20 as a covered diagnosis.
Showing top 6. Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing N04.20.
4 Medicare
CPT Codes Commonly Billed with N04.20
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To N04.20
Other codes in section N00-N08 (Glomerular diseases).
ICD-10 N04.20, Billing FAQ
Is ICD-10 code N04.20 billable? +
Yes, N04.20 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to N04.20? +
ICD-10 N04.20 includes: Membranous nephropathy NOS with nephrotic syndrome.
Is N04.20 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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