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v1.0.0
ICD-10 Guide
ICD-10 CodesQ64.3

Q64.3

Billable

Other atresia and stenosis of urethra and bladder neck

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 Q64.3 is a billable code used to indicate a diagnosis of other atresia and stenosis of urethra and bladder neck.

Key Diagnostic Point:

Q64.3 refers to congenital malformations characterized by the abnormal narrowing (stenosis) or complete obstruction (atresia) of the urethra and bladder neck. These conditions can lead to significant urinary tract complications, including hydronephrosis, urinary retention, and recurrent urinary tract infections. In pediatric patients, these malformations may present with symptoms such as difficulty urinating, abdominal distension, or failure to thrive. Associated congenital anomalies may include renal agenesis, where one or both kidneys fail to develop, and bladder exstrophy, a condition where the bladder is exposed outside the body. The management of these conditions often requires a multidisciplinary approach, including urologists, nephrologists, and geneticists, to address both the immediate urinary issues and any underlying genetic syndromes that may be present.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of symptoms
  • Potential for associated congenital anomalies
  • Need for multidisciplinary documentation
  • Differentiation from similar conditions

Audit Risk Factors

  • Inaccurate documentation of associated congenital anomalies
  • Failure to capture all relevant clinical details
  • Misinterpretation of symptoms leading to incorrect coding
  • Inconsistent use of codes across different healthcare settings

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical notes on urinary symptoms, growth parameters, and any imaging studies performed.

Common Clinical Scenarios

Pediatric patients presenting with urinary retention, abdominal distension, or failure to thrive due to urinary obstruction.

Billing Considerations

Consideration of developmental milestones and potential impact of urinary issues on growth and development.

Genetics

Documentation Requirements

Genetic testing results, family history of congenital anomalies, and any syndromic associations.

Common Clinical Scenarios

Patients with multiple congenital anomalies requiring genetic counseling and evaluation for syndromic conditions.

Billing Considerations

Awareness of chromosomal abnormalities that may be associated with urinary tract malformations.

Coding Guidelines

Inclusion Criteria

Use Q64.3 When
  • Follow official ICD
  • CM guidelines for coding congenital conditions, ensuring accurate documentation of associated anomalies and clinical findings
  • Use additional codes as necessary to capture the full clinical picture

Exclusion Criteria

Do NOT use Q64.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

CPT 51700CPT Code

Cystourethrogram

Clinical Scenario

Used to evaluate urinary tract anatomy in patients with suspected atresia or stenosis.

Documentation Requirements

Document indications for the procedure and findings.

Specialty Considerations

Urology specialists should ensure accurate coding based on findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital urinary malformations, improving the ability to capture the complexity of these conditions and their management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital urinary malformations, improving the ability to capture the complexity of these conditions and their management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital urinary malformations, improving the ability to capture the complexity of these conditions and their management.

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 associated conditions with Q64.3?

Common associated conditions include renal agenesis, bladder exstrophy, and posterior urethral valves. Accurate coding requires documentation of these associations.