N18.4
Chronic kidney disease, stage 4 (severe)
HCC risk adjustment mapping
CMS-HCC V28
Chronic Kidney Disease, Severe (Stage 4)
CMS-HCC ESRD V24
Chronic Kidney Disease, Severe (Stage 4)
RxHCC V08
Chronic Kidney Disease Stage 4
Coding notes
Excludes 1 never coded together · Excludes 2 may co-exist
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)
certain conditions originating in the perinatal period (P04-P96) certain infectious and parasitic diseases (A00-B99) complications of pregnancy, childbirth and the puerperium (O00-O9A) congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) endocrine, nutritional and metabolic diseases (E00-E88) injury, poisoning and certain other consequences of external causes (S00-T88) neoplasms (C00-D49) symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Official Guidelines for N18.4
FY 2026 ›Sections that reference N18.4
- I.C.14.a.1)Stages of chronic kidney disease (CKD)
… stages 1-5. Stage 2, code N18.2, equates to mild CKD; stage 3, codes N18.30-N18.32, equate to moderate CKD; and stage 4, code N18.4, equates to severe CKD. Code N18.6, End stage renal disease (ESRD), is assigned when the provider has documented end- stage …
- I.C.9.a.2)Hypertensive Chronic Kidney DiseaseChapter 9
… codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present. …
- I.C.9.a.3)Hypertensive Heart and Chronic Kidney DiseaseChapter 9
… The appropriate code from category N18, Chronic kidney disease, should be used as a secondary code with a code from category I13 to identify the stage of chronic …
- I.C.14.a.2)Chronic kidney disease and kidney transplant status
… Assign the appropriate N18 code for the patient’s stage of CKD and code Z94.0, Kidney transplant status. …
Sections whose FY 2026 text names N18.4, its N18 category, or a range containing it — the chapter guidance above is the authoritative source.
Find N18.4 in the alphabetic index
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