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ICD-10 Guide
ICD-10 CodesN13.7

N13.7

Billable

Vesicoureteral-reflux

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/18/2025

Code Description

ICD-10 N13.7 is a billable code used to indicate a diagnosis of vesicoureteral-reflux.

Key Diagnostic Point:

Vesicoureteral reflux (VUR) is a condition characterized by the abnormal flow of urine from the bladder back into the ureters and potentially into the kidneys. This condition can lead to recurrent urinary tract infections (UTIs), pyelonephritis, and hydronephrosis due to the increased pressure and potential damage to the renal parenchyma. In children, VUR is often congenital, while in adults, it may result from bladder outlet obstruction or neurogenic bladder. The severity of VUR is classified into grades I to V, with higher grades indicating more severe reflux and a greater risk of renal complications. Patients with VUR may present with symptoms such as fever, flank pain, and dysuria, and may require imaging studies such as a voiding cystourethrogram (VCUG) to confirm the diagnosis. Management often includes antibiotic prophylaxis to prevent UTIs, and in severe cases, surgical intervention may be necessary to correct the reflux. Understanding the implications of VUR is crucial for preventing long-term renal damage and ensuring appropriate treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between grades of reflux
  • Identifying associated conditions like pyelonephritis and hydronephrosis
  • Understanding the need for imaging studies
  • Managing antibiotic prophylaxis and treatment plans

Audit Risk Factors

  • Inadequate documentation of reflux severity
  • Failure to document recurrent UTIs
  • Lack of imaging study results in the medical record
  • Incorrect coding of associated renal complications

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed history of urinary tract infections, imaging results, and treatment plans.

Common Clinical Scenarios

Children presenting with recurrent UTIs or febrile illnesses.

Billing Considerations

Consideration of congenital anomalies and developmental milestones.

Urology

Documentation Requirements

Comprehensive assessment of urinary function, imaging studies, and surgical notes if applicable.

Common Clinical Scenarios

Adults with bladder outlet obstruction or neurogenic bladder presenting with VUR.

Billing Considerations

Documentation of surgical interventions and follow-up care.

Coding Guidelines

Inclusion Criteria

Use N13.7 When
  • According to ICD
  • 10 guidelines, N13
  • 7 should be used when there is documented vesicoureteral reflux with associated complications
  • It is important to include details about the severity of reflux and any related renal conditions

Exclusion Criteria

Do NOT use N13.7 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

CPT 52000CPT Code

Cystourethroscopy

Clinical Scenario

Used to evaluate the bladder and urethra in patients with suspected VUR.

Documentation Requirements

Document indications for the procedure and findings.

Specialty Considerations

Urology specialists should ensure detailed procedural notes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like VUR, improving the accuracy of data collection and reimbursement processes. It emphasizes the importance of detailed documentation regarding the severity and complications of the condition.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like VUR, improving the accuracy of data collection and reimbursement processes. It emphasizes the importance of detailed documentation regarding the severity and complications of the condition.

Reimbursement & Billing Impact

reimbursement processes. It emphasizes the importance of detailed documentation regarding the severity and complications of the condition.

Resources

Clinical References

  • •
    American Urological Association Guidelines

Coding & Billing References

  • •
    American Urological Association Guidelines

Frequently Asked Questions

What are the common complications associated with vesicoureteral reflux?

Common complications include recurrent urinary tract infections, pyelonephritis, hydronephrosis, and potential long-term renal damage if left untreated.