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v1.0.0
ICD-10 Guide
ICD-10 CodesChapter 14: Diseases of the genitourinary systemN42

N42

Billable

Other and unspecified disorders of prostate

Chapter 14:Diseases of the genitourinary system

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

Code Description

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

Key Diagnostic Point:

N42 encompasses a variety of prostate disorders that do not fit neatly into other specific categories. This includes conditions such as benign prostatic hyperplasia (BPH), prostatitis, and other unspecified prostate disorders. BPH is characterized by the non-cancerous enlargement of the prostate gland, leading to urinary symptoms such as increased frequency, urgency, and difficulty in urination. Prostatitis refers to inflammation of the prostate, which can be acute or chronic and may present with pelvic pain, urinary issues, and systemic symptoms. The diagnosis of these conditions often involves evaluating prostate-specific antigen (PSA) levels, which can be elevated in various prostate disorders, necessitating careful interpretation to rule out malignancy. Urological procedures such as transurethral resection of the prostate (TURP) or prostate biopsies may be performed for diagnosis or treatment, further complicating the coding process. Accurate coding for N42 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 the code
  • Need for precise documentation of symptoms and treatments
  • Differentiation between benign and malignant conditions
  • Potential overlap with other prostate-related codes

Audit Risk Factors

  • Inadequate documentation of symptoms and treatment plans
  • Misclassification of benign versus malignant conditions
  • Failure to document PSA levels and their implications
  • Inconsistent use of terminology in clinical notes

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed clinical notes including symptoms, diagnostic tests (e.g., PSA levels), and treatment plans.

Common Clinical Scenarios

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

Billing Considerations

Ensure clear differentiation between types of prostate disorders and document any relevant procedures performed.

Primary Care

Documentation Requirements

Comprehensive patient history, symptom assessment, and referrals to urology if necessary.

Common Clinical Scenarios

Routine screenings for prostate health, management of urinary symptoms, and follow-up on PSA results.

Billing Considerations

Document any referrals or consultations with specialists to support coding decisions.

Coding Guidelines

Inclusion Criteria

Use N42 When
  • According to ICD
  • 10 coding guidelines, N42 should be used when the specific disorder of the prostate is not clearly defined
  • Coders must ensure that the documentation supports the use of this code and that it is not more accurately represented by a more specific code

Exclusion Criteria

Do NOT use N42 When
No specific exclusions found.

Related CPT Codes

52601CPT Code

Transurethral resection of the prostate

Clinical Scenario

Used for patients diagnosed with BPH requiring surgical intervention.

Documentation Requirements

Operative reports detailing the procedure and indication for surgery.

Specialty Considerations

Urologists must document the rationale for surgery and any pre-operative evaluations.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of prostate disorders, improving the accuracy of diagnoses and treatment tracking. N42 serves as a catch-all for unspecified disorders, emphasizing the need for thorough documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of prostate disorders, improving the accuracy of diagnoses and treatment tracking. N42 serves as a catch-all for unspecified disorders, emphasizing the need for thorough documentation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of prostate disorders, improving the accuracy of diagnoses and treatment tracking. N42 serves as a catch-all for unspecified disorders, emphasizing the need for thorough documentation.

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 conditions are included under N42?

N42 includes various unspecified disorders of the prostate, such as benign prostatic hyperplasia and prostatitis, but does not include malignant conditions.