His first sentence doesn't make a lot of sense to me - Let me see if I can re-word it correctly: Is he saying that the kidney disease was caused by a loss of renal mass, which is due to a nephrectomy? The use of the words "combination of" is what's throwing me off - it makes me think that 2 different things should be impacting the situation in separate ways, not that one is the cause of the other - so I'd need to have clarification on whether the nephrectomy and loss of renal mass are related to each other or not, if I were in your shoes.
You're right about the code selection not sounding correct - A nephrectomy is the surgical removal of the kidney, which wouldn't be possible if it were congenitally absent. The doctor's code selection is contradicting his "findings" notes.
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