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v1.0.0
ICD-10 Guide
ICD-10 CodesN42.30

N42.30

Billable

Unspecified dysplasia of prostate

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

Code Description

ICD-10 N42.30 is a billable code used to indicate a diagnosis of unspecified dysplasia of prostate.

Key Diagnostic Point:

Unspecified dysplasia of the prostate refers to abnormal growth or development of prostate cells that does not fit into the defined categories of benign prostatic hyperplasia (BPH) or prostate cancer. Dysplasia can be a precursor to more serious conditions and is often identified during routine examinations or imaging studies. Patients may present with symptoms such as urinary frequency, urgency, and difficulty in urination, which are common in various prostate disorders. The condition may be associated with elevated prostate-specific antigen (PSA) levels, prompting further investigation. Diagnosis typically involves a combination of clinical evaluation, imaging, and possibly biopsy to assess the nature of the dysplasia. Management may include monitoring, lifestyle modifications, and in some cases, surgical interventions. Understanding the nuances of prostate disorders, including prostatitis and BPH, is crucial for accurate coding and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Overlap with other prostate conditions (e.g., BPH, prostatitis)
  • Need for comprehensive documentation to support diagnosis
  • Potential for misclassification with prostate cancer

Audit Risk Factors

  • Inadequate documentation of symptoms and clinical findings
  • Failure to provide supporting evidence for diagnosis
  • Misuse of unspecified codes leading to potential denials
  • Inconsistent coding practices across providers

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed clinical notes including patient history, physical examination findings, and results of diagnostic tests.

Common Clinical Scenarios

Patients presenting with urinary symptoms, elevated PSA levels, or abnormal findings on imaging.

Billing Considerations

Ensure clear differentiation between dysplasia and other prostate conditions to avoid coding errors.

Primary Care

Documentation Requirements

Comprehensive patient history and symptom assessment, including any referrals to urology.

Common Clinical Scenarios

Routine screenings for prostate health, management of urinary symptoms, and follow-up on PSA results.

Billing Considerations

Document any referrals and consultations with specialists to support the diagnosis.

Coding Guidelines

Inclusion Criteria

Use N42.30 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • 30 should be used when there is no specific diagnosis available, and the provider has documented dysplasia without further classification

Exclusion Criteria

Do NOT use N42.30 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

55700CPT Code

Prostate biopsy

Clinical Scenario

Used when a biopsy is performed to evaluate for dysplasia or malignancy.

Documentation Requirements

Document the indication for biopsy, findings, and any complications.

Specialty Considerations

Urologists should ensure that the biopsy results are clearly linked to the diagnosis of dysplasia.

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 dysplasia. This specificity aids in better tracking of patient outcomes and resource allocation in urology.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of prostate disorders, including dysplasia. This specificity aids in better tracking of patient outcomes and resource allocation in urology.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of prostate disorders, including dysplasia. This specificity aids in better tracking of patient outcomes and resource allocation in urology.

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 is the difference between dysplasia and BPH?

Dysplasia refers to abnormal cell growth that may indicate a risk for cancer, while BPH is a benign enlargement of the prostate that typically does not carry cancer risk. Accurate diagnosis is essential for appropriate coding.