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v1.0.0
ICD-10 Guide
ICD-10 CodesN42.0

N42.0

Billable

Calculus of prostate

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

Code Description

ICD-10 N42.0 is a billable code used to indicate a diagnosis of calculus of prostate.

Key Diagnostic Point:

Calculus of the prostate, also known as prostatic calculi, refers to the formation of stones within the prostate gland. These stones can develop due to various factors, including chronic inflammation, urinary stasis, and the presence of prostatic secretions that can calcify. Patients with prostatic calculi may experience symptoms such as pelvic pain, dysuria, and urinary obstruction. The condition is often associated with benign prostatic hyperplasia (BPH) and prostatitis, which can exacerbate the formation of calculi. Diagnosis typically involves imaging studies such as ultrasound or CT scans, and the presence of calculi can be confirmed through transrectal ultrasound. Management may include conservative measures, such as increased hydration and monitoring, or more invasive procedures like transurethral resection if significant obstruction or recurrent infections occur. Understanding the relationship between prostatic calculi and other prostate disorders is crucial for effective treatment and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of prostate disorders (BPH, prostatitis, etc.)
  • Understanding the relationship between calculi and urinary symptoms
  • Interpreting imaging studies for accurate diagnosis
  • Managing co-existing conditions that may complicate treatment

Audit Risk Factors

  • Inadequate documentation of symptoms related to calculi
  • Failure to document imaging studies that confirm diagnosis
  • Misclassification of the type of prostate disorder
  • Inconsistent coding of co-existing conditions

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed documentation of symptoms, imaging results, and treatment plans is essential. Urologists should provide clear notes on the patient's history of urinary symptoms and any previous treatments.

Common Clinical Scenarios

Patients presenting with recurrent urinary tract infections, pelvic pain, or obstructive urinary symptoms may be evaluated for prostatic calculi.

Billing Considerations

Urologists should be aware of the potential for calculi to complicate other prostate conditions and ensure comprehensive documentation of all findings.

Primary Care

Documentation Requirements

Primary care providers should document the patient's history, presenting symptoms, and any referrals made to urology for further evaluation.

Common Clinical Scenarios

Patients with chronic urinary symptoms or those being monitored for BPH may be referred for evaluation of prostatic calculi.

Billing Considerations

Primary care providers should ensure that they capture all relevant symptoms and any diagnostic tests ordered to support the coding process.

Coding Guidelines

Inclusion Criteria

Use N42.0 When
  • According to ICD
  • 10 guidelines, N42
  • 0 should be used when there is a confirmed diagnosis of prostatic calculi
  • It is important to document the presence of symptoms and any imaging studies that support the diagnosis

Exclusion Criteria

Do NOT use N42.0 When
  • Exclusion criteria include conditions that do not involve calculi but may present with similar symptoms

Related ICD-10 Codes

Related CPT Codes

52601CPT Code

Transurethral resection of the prostate (TURP)

Clinical Scenario

Used when prostatic calculi cause significant obstruction requiring surgical intervention.

Documentation Requirements

Documentation must include the indication for surgery, findings during the procedure, and post-operative care.

Specialty Considerations

Urologists should ensure that all relevant clinical information is documented to support the need for surgical intervention.

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, including prostatic calculi. This specificity aids in better tracking of patient outcomes and resource utilization.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of prostate disorders, including prostatic calculi. This specificity aids in better tracking of patient outcomes and resource utilization.

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 symptoms indicate the need for coding N42.0?

Symptoms such as pelvic pain, dysuria, urinary obstruction, and recurrent urinary tract infections may indicate the presence of prostatic calculi and warrant coding N42.0.