ICD-10 Coding for Benign Prostatic Hypertrophy with Obstruction(N40.1, N13.8)
Complete ICD-10-CM coding and documentation guide for Benign Prostatic Hypertrophy with Obstruction. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Benign Prostatic Hypertrophy with Obstruction
N40-N51Primary Range
Diseases of male genital organs
This range includes codes for benign prostatic hyperplasia and related conditions.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N40.1 | Benign prostatic hyperplasia with lower urinary tract symptoms | Use when BPH is accompanied by documented LUTS. |
|
| N13.8 | Other obstructive and reflux uropathy | Use when obstruction is confirmed and documented. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for benign prostatic hypertrophy with obstruction
Essential facts and insights about Benign Prostatic Hypertrophy with Obstruction
Primary ICD-10-CM Codes for benign prostatic hypertrophy with obstruction
Decision Criteria
clinical Criteria
- Presence of LUTS and prostate enlargement
documentation Criteria
- Detailed documentation of LUTS and obstruction
Applicable To
- BPH with LUTS
- Prostate enlargement with urinary obstruction
Excludes
- Malignant neoplasm of prostate (C61)
Clinical Validation Requirements
- Documented LUTS
- Prostate enlargement confirmed by imaging or examination
Code-Specific Risks
- Ensure LUTS are documented to avoid incorrect coding.
Coding Notes
- Ensure documentation specifies LUTS and obstruction if present.
N13.8 - Other obstructive and reflux uropathy
Use when obstruction is confirmed and documented.
Applicable To
- Obstructive uropathy due to BPH
Excludes
- Obstruction due to malignancy
Clinical Validation Requirements
- Imaging or urodynamic confirmation of obstruction
Coding Notes
Ensure obstruction is documented and confirmed.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other obstructive and reflux uropathy
N13.8Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Benign Prostatic Hypertrophy with Obstruction to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N40.1.
Impact
Clinical: Inadequate clinical picture, Regulatory: Potential audit issues, Financial: Claim denials
Mitigation Strategy
Use templates to ensure complete documentation, Regular training on documentation standards
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure LUTS are documented in the medical record.
Impact
Risk of audits due to insufficient documentation of LUTS.
Mitigation Strategy
Implement thorough documentation practices and regular audits.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Benign Prostatic Hypertrophy with Obstruction, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Benign Prostatic Hypertrophy with Obstruction
Use these documentation templates to ensure complete and accurate documentation for Benign Prostatic Hypertrophy with Obstruction. These templates include all required elements for proper coding and billing.
Urology Clinic Visit
Specialty: UrologyRequired Elements
- Patient history
- Symptom description
- Physical exam findings
- Diagnostic test results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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