ICD-10 Coding for Prostatic Hypertrophy(N40.0, N40.1)
Complete ICD-10-CM coding and documentation guide for Prostatic Hypertrophy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Prostatic Hypertrophy
N40-N51Primary Range
Diseases of male genital organs
This range includes codes for prostatic hypertrophy 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 |
|---|---|---|---|
| N40.0 | Benign prostatic hyperplasia without lower urinary tract symptoms | Use when the patient has an enlarged prostate but no lower urinary tract symptoms. |
|
| N40.1 | Benign prostatic hyperplasia with lower urinary tract symptoms | Use when the patient has an enlarged prostate with documented lower urinary tract symptoms. |
|
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 prostatic hypertrophy
Essential facts and insights about Prostatic Hypertrophy
Primary ICD-10-CM Codes for prostatic hypertrophy
Decision Criteria
clinical Criteria
- No urinary symptoms reported
Applicable To
- Asymptomatic prostatic enlargement
Excludes
- Benign prostatic hyperplasia with LUTS (N40.1)
Clinical Validation Requirements
- Digital rectal exam showing enlarged prostate
- No reported urinary symptoms
Code-Specific Risks
- Incorrectly coding when symptoms are present
Coding Notes
- Ensure documentation explicitly states absence of symptoms.
N40.1 - Benign prostatic hyperplasia with lower urinary tract symptoms
Use when the patient has an enlarged prostate with documented lower urinary tract symptoms.
Applicable To
- BPH with LUTS
Excludes
- Benign prostatic hyperplasia without LUTS (N40.0)
Clinical Validation Requirements
- Documented lower urinary tract symptoms
- IPSS score indicating symptom severity
Coding Notes
Ensure LUTS are clearly documented in the medical record.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Prostatic Hypertrophy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N40.0.
Impact
Clinical: Inaccurate symptom assessment, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Use specific symptom language, Regular training on documentation standards
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure LUTS are explicitly documented before using N40.1.
Impact
Lack of specific symptom documentation can lead to audit issues.
Mitigation Strategy
Ensure all symptoms are clearly documented and linked to the diagnosis.
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 Prostatic Hypertrophy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Prostatic Hypertrophy
Use these documentation templates to ensure complete and accurate documentation for Prostatic Hypertrophy. These templates include all required elements for proper coding and billing.
Urology consultation for BPH
Specialty: UrologyRequired Elements
- Patient history
- IPSS score
- Physical exam findings
- Diagnostic test results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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