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v1.0.0
ICD-10 Guide
ICD-10 CodesN42.8

N42.8

Billable

Other specified disorders of prostate

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

Code Description

ICD-10 N42.8 is a billable code used to indicate a diagnosis of other specified disorders of prostate.

Key Diagnostic Point:

N42.8 encompasses a variety of prostate disorders that do not fall under more specific categories. This includes conditions such as prostatitis, benign prostatic hyperplasia (BPH), and other less common prostate disorders. Prostatitis can be acute or chronic and is characterized by inflammation of the prostate gland, often leading to pelvic pain and urinary symptoms. BPH, a common condition in older men, involves the enlargement of the prostate gland, which can obstruct urinary flow and lead to symptoms such as frequent urination, urgency, and nocturia. Elevated prostate-specific antigen (PSA) levels may indicate prostate disorders, prompting further evaluation. Urological procedures, such as transurethral resection of the prostate (TURP) or prostate biopsies, may be performed to diagnose or treat these conditions. Accurate coding for N42.8 requires a thorough understanding of the patient's clinical presentation and the specific nature of the prostate disorder being treated.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of conditions included under this code
  • Need for precise documentation to differentiate between disorders
  • Potential overlap with other prostate-related codes
  • Variability in clinical presentation and treatment options

Audit Risk Factors

  • Inadequate documentation of the specific prostate disorder
  • Misclassification of prostate conditions
  • Failure to document associated symptoms or treatments
  • Inconsistent use of terminology in clinical notes

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed clinical notes on symptoms, diagnostic tests, and treatment plans are essential.

Common Clinical Scenarios

Patients presenting with urinary symptoms, elevated PSA levels, or diagnosed prostatitis.

Billing Considerations

Urologists must ensure that all relevant diagnostic tests and procedures are documented to support the use of N42.8.

Primary Care

Documentation Requirements

Comprehensive patient history and physical examination findings related to prostate health.

Common Clinical Scenarios

Routine screening for prostate disorders in older male patients or management of chronic prostatitis.

Billing Considerations

Primary care providers should document referrals to urology for further evaluation of prostate disorders.

Coding Guidelines

Inclusion Criteria

Use N42.8 When
  • According to ICD
  • 10 coding guidelines, N42
  • 8 should be used when the specific disorder of the prostate is not classified elsewhere
  • Coders must ensure that the documentation supports the diagnosis and that the condition is not better described by a more specific code

Exclusion Criteria

Do NOT use N42.8 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

52601CPT Code

Transurethral resection of the prostate (TURP)

Clinical Scenario

Used for patients with BPH or other obstructive prostate disorders.

Documentation Requirements

Operative report must detail the indication for surgery and findings.

Specialty Considerations

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

55700CPT Code

Prostate biopsy

Clinical Scenario

Performed when PSA levels are elevated or prostate abnormalities are detected.

Documentation Requirements

Pathology report and clinical notes must support the need for biopsy.

Specialty Considerations

Urologists must document the rationale for biopsy to justify coding.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more detailed coding of prostate disorders, improving the specificity of diagnoses. N42.8 serves as a catch-all for unspecified disorders, which can help in tracking and managing less common prostate conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more detailed coding of prostate disorders, improving the specificity of diagnoses. N42.8 serves as a catch-all for unspecified disorders, which can help in tracking and managing less common prostate conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more detailed coding of prostate disorders, improving the specificity of diagnoses. N42.8 serves as a catch-all for unspecified disorders, which can help in tracking and managing less common prostate conditions.

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

When should I use N42.8 instead of more specific codes?

N42.8 should be used when the specific type of prostate disorder is not documented or when the condition does not fit into other specified categories. Always strive for the most specific code available.