ICD-10 Coding for Ureteral Calculus(N20.1, N13.2)
Complete ICD-10-CM coding and documentation guide for Ureteral Calculus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Ureteral Calculus
N20-N23Primary Range
Calculus of kidney and ureter
This range includes codes for stones in the kidney and ureter, which are relevant for ureteral calculus.
Obstructive and reflux uropathy
This range includes codes for conditions like hydronephrosis with obstruction, which can be caused by ureteral calculus.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N20.1 | Calculus of ureter | Use when a ureteral stone is present without hydronephrosis or obstruction. |
|
| N13.2 | Hydronephrosis with ureteral obstruction | Use when a ureteral stone causes hydronephrosis. |
|
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 ureteral calculus
Essential facts and insights about Ureteral Calculus
Primary ICD-10-CM Codes for ureteral calculus
Decision Criteria
clinical Criteria
- Presence of ureteral stone without hydronephrosis
Applicable To
- Ureterolithiasis
Excludes
- N13.2 (Hydronephrosis with ureteral obstruction)
Clinical Validation Requirements
- CT scan showing ureteral stone
- Patient symptoms such as flank pain
Code-Specific Risks
- Incorrectly coding when hydronephrosis is present
Coding Notes
- Ensure documentation specifies the absence of hydronephrosis.
N13.2 - Hydronephrosis with ureteral obstruction
Use when a ureteral stone causes hydronephrosis.
Applicable To
- Obstructive uropathy due to ureteral stone
Excludes
- N20.1 (Calculus of ureter without obstruction)
Clinical Validation Requirements
- Imaging showing hydronephrosis and ureteral obstruction
- Symptoms of obstructive uropathy
Coding Notes
Ensure documentation clearly indicates obstruction due to the stone.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Ureteral Calculus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N20.1.
Impact
Clinical: Impacts treatment decisions, Regulatory: Leads to coding inaccuracies, Financial: May affect reimbursement rates
Mitigation Strategy
Always document left or right side, Use templates that prompt for laterality
Impact
Reimbursement: Incorrect sequencing can affect DRG assignment., Compliance: Violates ICD-10 Excludes1 note., Data Quality: Leads to inaccurate clinical data.
Mitigation Strategy
Use N13.2 exclusively when hydronephrosis is present.
Impact
Using N20.1 and N13.2 together when hydronephrosis is present.
Mitigation Strategy
Educate coders on Excludes1 notes and proper sequencing.
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 Ureteral Calculus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Ureteral Calculus
Use these documentation templates to ensure complete and accurate documentation for Ureteral Calculus. These templates include all required elements for proper coding and billing.
Ureteral stone with hydronephrosis
Specialty: UrologyRequired Elements
- Stone location and size
- Presence of hydronephrosis
- Symptoms and imaging findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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