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Renal Stone Disease K003

Document
Last amended 
25 June 2015
Current RMA Instruments:
Reasonable Hypothesis SOP
65 of 2010
Balance of Probabilities SOP
66 of 2010
Changes from Previous Instruments:

SOP Bulletin 146

ICD Coding:
  • CD-9-CM Codes: 274.11,592.0,592.1
  • ICD-10-AM Codes: N20.0, N20.1, N20.2

This SOP covers stones (calculi) in the kidney or ureter.

Is specific diagnostic evidence required to apply either SOP?No. 
Are there sub-factors that require specific information? – Yes.

There is one factor specific to staghorn calculi (ammonium phosphate stones) only.

Additional diagnoses covered by SOP
  • Kidney stone
  • Renal calculus
  • Staghorn calculus
  • Ureteric calculus
  • Ureterolithiasis
  • Nephrolithiasis
Conditions not covered by SOP
  • Cholelithiasis (gallstones), ICD code 574
  • Bladder stones (primary), ICD codes 594
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 may be useful in establishing the diagnosis:

  • Report from treating doctor
  • Report of imaging procedure (X-Ray, Ultrasound)