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v1.0.0
ICD-10 Guide
ICD-10 CodesN21.1

N21.1

Billable

Calculus in urethra

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

Code Description

ICD-10 N21.1 is a billable code used to indicate a diagnosis of calculus in urethra.

Key Diagnostic Point:

Calculus in the urethra refers to the presence of stones or mineral deposits that form within the urethra, the tube that carries urine from the bladder to the outside of the body. Urethral calculi can result from various factors, including dehydration, dietary habits, and metabolic disorders. These stones can cause significant discomfort, urinary obstruction, and may lead to complications such as urinary tract infections (UTIs) or kidney damage if not addressed promptly. Patients may present with symptoms such as hematuria (blood in urine), dysuria (painful urination), and urinary retention. Diagnosis typically involves imaging studies such as ultrasound or CT scans, and treatment options may include lithotripsy, which uses shock waves to break up stones, or surgical removal in more severe cases. Dietary modifications, such as increased fluid intake and reduced intake of oxalate-rich foods, can help prevent recurrence. Understanding the underlying causes and appropriate management strategies is crucial for effective treatment and prevention of urethral calculi.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and symptoms among patients
  • Need for precise documentation of stone location and size
  • Potential for associated conditions (e.g., UTIs) that may complicate coding
  • Differentiation from other types of urinary calculi (e.g., kidney stones, ureteral stones)

Audit Risk Factors

  • Inadequate documentation of symptoms and treatment
  • Failure to specify the location of the calculus
  • Misclassification of the type of calculus
  • Lack of supporting imaging studies in the medical record

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed documentation of the patient's symptoms, imaging results, and treatment plan is essential.

Common Clinical Scenarios

Patients presenting with acute urinary obstruction, recurrent UTIs, or hematuria.

Billing Considerations

Urologists must document the size and location of the calculus, as well as any surgical interventions performed.

Primary Care

Documentation Requirements

Comprehensive history and physical examination findings, including dietary habits and fluid intake.

Common Clinical Scenarios

Patients with recurrent urinary symptoms or those with a history of urolithiasis.

Billing Considerations

Primary care providers should document referrals to specialists and any preventive measures discussed with the patient.

Coding Guidelines

Inclusion Criteria

Use N21.1 When
  • According to ICD
  • 10 guidelines, N21
  • 1 should be used when there is clear documentation of calculus located specifically in the urethra
  • It is important to differentiate this from other urinary calculi codes
  • Ensure that the documentation supports the diagnosis and any associated conditions

Exclusion Criteria

Do NOT use N21.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

52332CPT Code

Cystourethroscopy with removal of foreign body

Clinical Scenario

Used when a urethral calculus requires surgical intervention.

Documentation Requirements

Document the procedure performed, findings, and any complications.

Specialty Considerations

Urologists should ensure that the procedure is clearly linked to the diagnosis of urethral calculus.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of urethral calculi, improving the accuracy of data collection and reimbursement processes. It has also facilitated better tracking of treatment outcomes and patient management strategies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of urethral calculi, improving the accuracy of data collection and reimbursement processes. It has also facilitated better tracking of treatment outcomes and patient management strategies.

Reimbursement & Billing Impact

reimbursement processes. It has also facilitated better tracking of treatment outcomes and patient management strategies.

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 symptoms of urethral calculus?

Common symptoms include painful urination (dysuria), blood in urine (hematuria), and urinary retention. Patients may also experience severe pelvic or abdominal pain.

How is urethral calculus diagnosed?

Diagnosis typically involves imaging studies such as ultrasound or CT scans, along with a review of the patient's symptoms and medical history.

What treatment options are available for urethral calculi?

Treatment options include lithotripsy to break up stones, surgical removal, and dietary modifications to prevent recurrence.