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v1.0.0
ICD-10 Guide
ICD-10 CodesN42.1

N42.1

Billable

Congestion and hemorrhage of prostate

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

Code Description

ICD-10 N42.1 is a billable code used to indicate a diagnosis of congestion and hemorrhage of prostate.

Key Diagnostic Point:

Congestion and hemorrhage of the prostate gland can occur due to various underlying conditions, including benign prostatic hyperplasia (BPH), prostatitis, or other prostate disorders. BPH is characterized by the enlargement of the prostate, which can lead to urinary obstruction and increased pressure within the gland. This pressure can result in congestion, where blood flow is impeded, leading to localized swelling and potential hemorrhage. Prostatitis, an inflammation of the prostate, can also contribute to these symptoms, often presenting with pain, difficulty urinating, and systemic symptoms like fever. Elevated prostate-specific antigen (PSA) levels may be observed in these conditions, necessitating further evaluation to rule out malignancy. Urological procedures, such as transurethral resection of the prostate (TURP) or prostate biopsies, may be indicated for diagnosis or treatment, and the presence of congestion and hemorrhage can complicate these interventions. Accurate coding of N42.1 is essential for proper management and reimbursement, as it reflects the complexity of prostate-related disorders and their impact on patient care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between various prostate disorders (BPH, prostatitis, etc.)
  • Understanding the implications of elevated PSA levels
  • Documenting the presence of congestion and hemorrhage accurately
  • Linking symptoms to the correct diagnosis

Audit Risk Factors

  • Inadequate documentation of symptoms leading to congestion and hemorrhage
  • Failure to link the diagnosis with appropriate treatment procedures
  • Misinterpretation of PSA levels in relation to the diagnosis
  • Inconsistent coding of related conditions

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Comprehensive documentation of symptoms, diagnostic tests (including PSA levels), and treatment plans.

Common Clinical Scenarios

Patients presenting with urinary obstruction, pelvic pain, or abnormal PSA results.

Billing Considerations

Ensure that all relevant diagnostic tests and procedures are documented to support the coding of N42.1.

Primary Care

Documentation Requirements

Detailed patient history, physical examination findings, and any referrals to urology.

Common Clinical Scenarios

Patients with urinary symptoms or those undergoing routine screening for prostate disorders.

Billing Considerations

Document any referrals or follow-up care related to prostate health.

Coding Guidelines

Inclusion Criteria

Use N42.1 When
  • According to ICD
  • 10 guidelines, N42
  • 1 should be used when there is clear documentation of congestion and hemorrhage of the prostate
  • It is important to ensure that the diagnosis is supported by clinical findings and that any related procedures are accurately coded

Exclusion Criteria

Do NOT use N42.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

52601CPT Code

Transurethral resection of the prostate (TURP)

Clinical Scenario

Used in cases of severe BPH with congestion and hemorrhage.

Documentation Requirements

Operative report detailing findings of congestion and hemorrhage.

Specialty Considerations

Urologists should ensure that the diagnosis aligns with the procedure performed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of prostate disorders, including N42.1, which captures the nuances of congestion and hemorrhage. This specificity aids in better patient management and appropriate reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of prostate disorders, including N42.1, which captures the nuances of congestion and hemorrhage. This specificity aids in better patient management and appropriate reimbursement.

Reimbursement & Billing Impact

reimbursement.

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 symptoms are associated with N42.1?

Symptoms may include urinary obstruction, pelvic pain, hematuria, and signs of infection. Elevated PSA levels may also be present.

How do I differentiate N42.1 from other prostate codes?

N42.1 specifically indicates congestion and hemorrhage, while other codes may refer to benign prostatic hyperplasia or prostatitis without these complications.