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v1.0.0
ICD-10 Guide
ICD-10 CodesN35.816

N35.816

Billable

Other urethral stricture, male, overlapping sites

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

Code Description

ICD-10 N35.816 is a billable code used to indicate a diagnosis of other urethral stricture, male, overlapping sites.

Key Diagnostic Point:

N35.816 refers to a condition characterized by the narrowing of the male urethra at overlapping sites, which can lead to various urinary symptoms and complications. Urethral strictures can arise from a variety of causes, including trauma, infection, or inflammation, and may be associated with conditions such as urethritis. The stricture can impede the flow of urine, leading to symptoms such as dysuria, urinary retention, and increased urinary frequency. Diagnosis typically involves a combination of patient history, physical examination, and imaging studies such as retrograde urethrograms. Treatment options may include dilation, urethrotomy, or surgical reconstruction, depending on the severity and location of the stricture. Accurate coding is essential for proper management and reimbursement, as well as for tracking the prevalence of this condition in the male population.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of overlapping sites and their implications.
  • Differentiation from other urethral stricture codes.
  • Need for precise documentation of the stricture's location and cause.
  • Potential for co-morbid conditions affecting urinary function.

Audit Risk Factors

  • Inadequate documentation of the stricture's location.
  • Failure to specify overlapping sites.
  • Misclassification of the stricture type.
  • Lack of supporting clinical evidence for the diagnosis.

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed notes on the patient's history, physical examination findings, and any imaging studies performed.

Common Clinical Scenarios

Patients presenting with urinary retention, recurrent urinary tract infections, or post-surgical complications.

Billing Considerations

Urologists should ensure that the documentation clearly indicates the nature of the stricture and any previous treatments.

Primary Care

Documentation Requirements

Comprehensive patient history and any referrals made to specialists.

Common Clinical Scenarios

Initial evaluation of urinary symptoms leading to referral for further management.

Billing Considerations

Primary care providers should document all relevant symptoms and any prior treatments to aid in accurate coding.

Coding Guidelines

Inclusion Criteria

Use N35.816 When
  • According to ICD
  • 10 guidelines, N35
  • 816 should be used when the urethral stricture is not classified elsewhere and involves overlapping sites
  • Coders must ensure that the documentation supports the diagnosis and that the stricture is not due to a known cause that has its own specific code

Exclusion Criteria

Do NOT use N35.816 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

52332CPT Code

Urethral dilation

Clinical Scenario

Used when treating a patient with a diagnosed urethral stricture.

Documentation Requirements

Document the indication for dilation and any findings during the procedure.

Specialty Considerations

Urologists should ensure that the procedure notes clearly indicate the type of stricture being treated.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of urethral strictures, improving the accuracy of data collection and reimbursement processes. N35.816 provides a distinct code for overlapping sites, which was not available in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of urethral strictures, improving the accuracy of data collection and reimbursement processes. N35.816 provides a distinct code for overlapping sites, which was not available in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. N35.816 provides a distinct code for overlapping sites, which was not available in ICD-9.

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 significance of overlapping sites in urethral strictures?

Overlapping sites indicate that the stricture affects multiple areas of the urethra, which can complicate treatment and may lead to more severe urinary symptoms.