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v1.0.0
ICD-10 Guide
ICD-10 CodesN13.8

N13.8

Billable

Other obstructive and reflux uropathy

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

Code Description

ICD-10 N13.8 is a billable code used to indicate a diagnosis of other obstructive and reflux uropathy.

Key Diagnostic Point:

N13.8 refers to a variety of conditions characterized by obstruction or reflux in the urinary tract that can lead to significant renal complications. This includes conditions such as pyelonephritis, which is an infection of the kidney often resulting from urinary obstruction, and interstitial nephritis, which can be caused by drug-induced nephropathy or infections. Hydronephrosis, the swelling of a kidney due to a build-up of urine, is a common consequence of obstructive uropathy. Patients may also experience recurrent urinary tract infections (UTIs) due to the stasis of urine, which provides a medium for bacterial growth. Management often involves antibiotic therapy to treat infections and may require surgical intervention to relieve obstruction. The complexity of coding for N13.8 arises from the need to accurately document the underlying causes, associated conditions, and the patient's clinical history to ensure appropriate coding and reimbursement.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of underlying causes (e.g., anatomical, infectious, drug-induced)
  • Need for detailed clinical documentation to support diagnosis
  • Potential for multiple co-existing conditions
  • Variability in treatment approaches and management strategies

Audit Risk Factors

  • Inadequate documentation of the underlying cause of obstruction
  • Failure to document recurrent urinary tract infections
  • Lack of clarity on the relationship between obstructive uropathy and renal function
  • Misclassification of pyelonephritis as a primary diagnosis without supporting evidence

Specialty Focus

Medical Specialties

Nephrology

Documentation Requirements

Detailed history of renal function, imaging studies, and laboratory results.

Common Clinical Scenarios

Patients with chronic kidney disease due to obstructive uropathy, recurrent pyelonephritis.

Billing Considerations

Ensure all renal function tests and imaging results are documented to support the diagnosis.

Urology

Documentation Requirements

Surgical reports, imaging studies, and patient history regarding urinary symptoms.

Common Clinical Scenarios

Patients undergoing surgical intervention for hydronephrosis or urinary obstruction.

Billing Considerations

Document the specifics of any surgical procedures performed and their outcomes.

Coding Guidelines

Inclusion Criteria

Use N13.8 When
  • According to ICD
  • CM guidelines, N13
  • 8 should be used when the specific cause of obstructive or reflux uropathy is not classified elsewhere
  • Coders must ensure that the documentation supports the diagnosis and that any associated conditions are also coded appropriately

Exclusion Criteria

Do NOT use N13.8 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

50590CPT Code

Lithotripsy, extracorporeal shock wave

Clinical Scenario

Used in cases of obstructive uropathy due to stones.

Documentation Requirements

Document the size and location of stones, and the patient's response to treatment.

Specialty Considerations

Urology specialists should ensure that all imaging and procedural notes are included.

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 N13.8, enabling better tracking of patient outcomes and more accurate reimbursement. It has also increased the need for detailed documentation to support the complexity of the diagnosis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like N13.8, enabling better tracking of patient outcomes and more accurate reimbursement. It has also increased the need for detailed documentation to support the complexity of the diagnosis.

Reimbursement & Billing Impact

reimbursement. It has also increased the need for detailed documentation to support the complexity of the diagnosis.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common causes of obstructive uropathy?

Common causes include kidney stones, tumors, strictures, and congenital abnormalities. Each of these can lead to urinary obstruction and subsequent renal complications.

How is N13.8 different from other uropathy codes?

N13.8 encompasses a broader range of obstructive and reflux uropathy conditions that are not classified elsewhere, making it essential to document the specific underlying causes.