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ICD-10 Guide
ICD-10 CodesN28.85

N28.85

Billable

Pyeloureteritis cystica

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

Code Description

ICD-10 N28.85 is a billable code used to indicate a diagnosis of pyeloureteritis cystica.

Key Diagnostic Point:

Pyeloureteritis cystica is a rare condition characterized by the presence of cystic lesions in the renal pelvis and ureter. These cysts are typically benign and may arise from the epithelial lining of the urinary tract. The condition can be associated with chronic irritation or obstruction, leading to inflammation of the renal pelvis (pyelitis) and ureter (ureteritis). Patients may present with symptoms such as flank pain, hematuria, or urinary tract infections. Diagnosis is often made through imaging studies, such as ultrasound or CT scans, which reveal cystic structures in the renal pelvis and ureter. Treatment may involve monitoring the condition, addressing any underlying causes, or surgical intervention if complications arise. Understanding the etiology and management of pyeloureteritis cystica is crucial for effective patient care and accurate coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Limited awareness of the condition among healthcare providers.
  • Variability in clinical presentation and symptoms.
  • Potential overlap with other urinary tract disorders.
  • Need for precise imaging documentation to support diagnosis.

Audit Risk Factors

  • Inadequate documentation of imaging findings.
  • Failure to specify the nature of cystic lesions.
  • Misclassification with malignant conditions.
  • Lack of clarity in the clinical rationale for diagnosis.

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed imaging reports and clinical notes describing symptoms and findings.

Common Clinical Scenarios

Patients presenting with recurrent urinary tract infections or unexplained flank pain.

Billing Considerations

Ensure clear documentation of cyst characteristics and any interventions performed.

Radiology

Documentation Requirements

Comprehensive imaging reports detailing the size, location, and characteristics of cysts.

Common Clinical Scenarios

Imaging studies performed for suspected urinary tract abnormalities.

Billing Considerations

Accurate descriptions of imaging findings are critical for proper coding.

Coding Guidelines

Inclusion Criteria

Use N28.85 When
  • According to ICD
  • 10 guidelines, N28
  • 85 should be used when the condition is specifically diagnosed and documented
  • It is important to ensure that the diagnosis is supported by imaging findings and clinical symptoms

Exclusion Criteria

Do NOT use N28.85 When
  • Exclusion criteria include conditions that do not involve cystic changes in the renal pelvis or ureter

Related ICD-10 Codes

Related CPT Codes

76700CPT Code

Ultrasound, abdomen, complete

Clinical Scenario

Used to evaluate for cystic lesions in the renal pelvis.

Documentation Requirements

Ultrasound report detailing findings and any abnormalities.

Specialty Considerations

Urologists and radiologists should ensure accurate reporting of cyst characteristics.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like pyeloureteritis cystica, improving the accuracy of patient records and facilitating better data collection for research and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like pyeloureteritis cystica, improving the accuracy of patient records and facilitating better data collection for research and treatment outcomes.

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 are the common symptoms of pyeloureteritis cystica?

Common symptoms include flank pain, hematuria, and recurrent urinary tract infections. Some patients may be asymptomatic.

How is pyeloureteritis cystica diagnosed?

Diagnosis is typically made through imaging studies such as ultrasound or CT scans that reveal cystic lesions in the renal pelvis and ureter.