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Obstructive and reflux nephropathy K009

Document
Last amended 
28 June 2015

Current RMA Instruments:

Reasonable Hypothesis SOP
31 of 2011
Balance of Probabilities SOP
32 of 2011
Changes from Previous Instruments:

SOP Bulletin 150

ICD Coding:
  • ICD-9-CM Codes: 591,593.5,599.6
  • ICD-10-AM Codes: N13

This is a condition in which obstruction to urine flow results in damage to the kidney and the upper urinary collection system (renal pelvis and ureter).  It can present in a number of ways, ranging from acute, with significant pain and other symptoms, through to chronic and insidious.  It can also be bilateral or unilateral.

Is specific diagnostic evidence required to apply the SOP?No.
Are there sub-factors that require specific information? – No.
Additional diagnoses covered by SOP
  • Hydronephrosis
  • Hydroureter
  • Obstructive nephropathy
  • Reflux nephropathy
Conditions not covered by SOP
  • Analgesic nephropathy, ICD code 583.89.
Unconfirmed diagnosis

If, after applying the above information, you are unable to confirm the diagnosis, you should then:

  1. seek medical officer advice about further investigation, or;
  2. generate a diagnostic report, or;
  3. re-encode the condition, if appropriate.

The following investigations may be useful in establishing the diagnosis.

  • Report from a nephrologist