Chronic kidney disease, stage 4 (severe)

This code signifies a severe and irreversible decline in kidney function, characterized by a glomerular filtration rate (GFR) between 15 and 29 mL/min/1.73 m$^2$. Patients at this stage often experience significant symptoms of uremia and require close monitoring for progression to end-stage renal disease.

Use this code when documentation clearly indicates a diagnosis of chronic kidney disease with a GFR consistently within the 15-29 mL/min/1.73 m$^2$ range. This stage often necessitates discussions about renal replacement therapy options such as dialysis or transplant. Supporting documentation includes laboratory results (e.g., GFR calculations, creatinine levels) and physician's assessment of CKD stage.

• Always confirm the specific GFR range to differentiate from other CKD stages.
• Do not code this if the documentation indicates acute kidney injury (AKI) or unspecified CKD.
• Sequence this code as a secondary diagnosis if an underlying cause of CKD (e.g., diabetes mellitus, hypertension) is also documented.