2024 ICD-10-CM Diagnosis Code Q61.3

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

• Autosomal dominant polycystic kidney disease
• Congenital hepatic fibrosis
• Neonatal diabetes, congenital hypothyroidism, congenital glaucoma, hepatic fibrosis, polycystic kidney syndrome
• NPHP3-related Meckel-like syndrome

Clinical Information

• Autosomal Dominant Polycystic Kidney Disease

  polycystic kidney disease inherited in an autosomal dominant pattern. symptoms usually appear at middle age and include abdominal pain, hematuria and high blood pressure. patients may develop brain aneurysms and liver cysts.

• Autosomal Dominant Polycystic Kidney Disease Type 2

  autosomal dominant polycystic kidney disease caused by a mutation in pkd2.

• Autosomal Dominant Polycystic Kidney Disease Type I

  autosomal dominant polycystic kidney disease caused by a mutation in pkd1.

• Polycystic Kidney Disease, Infantile Severe, with Tuberous Sclerosis|Autosomal Dominant Polycystic Kidney Disease Type 1 with Tuberous Sclerosis|PKDTS|TSC2-PKD1 Contiguous Gene Deletion Syndrome

  an autosomal dominant condition caused by a contiguous gene deletion involving the pkd1 and tsc2 genes, encoding polycystin-1 and tuberin respectively. it is characterized by polycystic kidneys and tuberous sclerosis.

• Polycystin-1|Autosomal Dominant Polycystic Kidney Disease Protein 1

  polycystin-1 (4303 aa, ~463 kda) is encoded by the human pkd1 gene. this protein may play a role in protein-protein and protein-carbohydrate interactions during kidney development.

• Congenital Hepatic Fibrosis

  a congenital disorder usually inherited in an autosomal recessive pattern. it affects the hepatobiliary system and the kidneys. it is characterized by liver fibrosis, portal hypertension, and renal cysts.

Q61.3 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
698	OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC	11	1.6544
699	OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC	11	1.0208
700	OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC	11	0.7083

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Present on Admission (POA)

Q61.3 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here.

CMS POA Indicator Options and Definitions

POA Indicator	Reason for Code	CMS will pay the CC/MCC DRG?
Y	Diagnosis was present at time of inpatient admission.	YES
N	Diagnosis was not present at time of inpatient admission.	NO
U	Documentation insufficient to determine if the condition was present at the time of inpatient admission.	NO
W	Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.	YES
1	Unreported/Not used - Exempt from POA reporting.	NO

Convert Q61.3 to ICD-9-CM

• ICD-9-CM Code: 753.12 - Polycystic kidney NOS

Patient Education

Kidney Cysts

A cyst is a fluid-filled sac. You may get simple kidney cysts as you age; they are usually harmless. There are also some diseases which cause kidney cysts. One type is polycystic kidney disease (PKD). It runs in families. In PKD, many cysts grow in the kidneys. This can enlarge the kidneys and make them work poorly. About half of people with the most common type of PKD end up with kidney failure. PKD also causes cysts in other parts of the body, such as the liver.

Often, there are no symptoms at first. Later, symptoms include:

• Pain in the back and lower sides
• Headaches
• Blood in the urine

Doctors diagnose PKD with imaging tests and family history. There is no cure. Treatments can help with symptoms and complications. They include medicines and lifestyle changes, and if there is kidney failure, dialysis or kidney transplants.

Acquired cystic kidney disease (ACKD) happens in people who have chronic kidney disease, especially if they are on dialysis. Unlike PKD, the kidneys are normal sized, and cysts do not form in other parts of the body. ACKD often has no symptoms. Usually, the cysts are harmless and do not need treatment. If they do cause complications, treatments include medicines, draining the cysts, or surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

[Learn More in MedlinePlus]

Polycystic kidney disease

Polycystic kidney disease is a disorder that affects the kidneys and other organs. Clusters of fluid-filled sacs, called cysts, develop in the kidneys and interfere with their ability to filter waste products from the blood. The growth of cysts causes the kidneys to become enlarged and can lead to kidney failure. Cysts may also develop in other organs, particularly the liver.

Frequent complications of polycystic kidney disease include dangerously high blood pressure (hypertension), pain in the back or sides, blood in the urine (hematuria), recurrent urinary tract infections, kidney stones, and heart valve abnormalities. Additionally, people with polycystic kidney disease have an increased risk of an abnormal bulging (an aneurysm) in a large blood vessel called the aorta or in blood vessels at the base of the brain. Aneurysms can be life-threatening if they tear or rupture.

The two major forms of polycystic kidney disease are distinguished by the usual age of onset and the pattern in which it is passed through families. The autosomal dominant form (sometimes called ADPKD) has signs and symptoms that typically begin in adulthood, although cysts in the kidney are often present from birth or childhood. Autosomal dominant polycystic kidney disease can be further divided into type 1 and type 2, depending on the genetic cause. The autosomal recessive form of polycystic kidney disease (sometimes called ARPKD) is much rarer and is often lethal early in life. The signs and symptoms of this condition are usually apparent at birth or in early infancy.

[Learn More in MedlinePlus]

Polycystic Kidney Disease (PKD)

Defines two types of polycystic kidney disease and describes their genetic origins, symptoms, diagnosis, and treatment, as well as ongoing research.
[Learn More in MedlinePlus]

Code History

• FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.