Obstructive and reflux nephropathy K009

Current RMA Instruments

Changes from previous Instruments

ICD Coding

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

Brief description

This is a condition in which obstruction or functional impediment of 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.

Confirming the diagnosis

The diagnosis is usually made using a combination of imaging (ultrasound, CT scan, MRI) and renal function testing.  Surgery (cystoscopy and related procedures) may also be undertaken.  The diagnostic evaluation will vary with the clinical circumstances (e.g. if due to obstruction, vs. in a spinal injury patient with a neurogenic bladder).

The relevant medical specialist is a nephrologist or urologist.

Additional diagnoses covered by SOP

• Hydronephrosis
• Hydroureter
• Obstructive nephropathy
• Reflux nephropathy

Conditions not covered by SOP

• Analgesic nephropathy*
• Transient urinary retention not due to a fixed mechanical obstruction - not a disease or injury

* another SOP applies

Clinical onset

Clinical onset can be based on commencement of relevant symptoms in some cases, but in others will correspond with the first time evidence of nephropathy is seen on medical investigation.  

Clinical worsening

Assessment of clinical worsening will be based on deterioration in renal function or evidence of worsening of renal deformity (hydronephrosis, hydroureter).