N36.0 — Urethral fistula
N36.0 is a billable, specific ICD-10-CM code for urethral fistula. It is valid for submission on a claim.
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Urethroperineal fistula
- Urethrorectal fistula
- Urinary fistula NOS
Risk adjustment
N36.0 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
N36.0 is named in 3 Medicare coverage policies — 3 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56421Billing and Coding: CT of the Abdomen and Pelvis
- A56802Billing and Coding: Urodynamics
- A57455Billing and Coding: Urodynamics
How N36.0 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to N36.0.
- Fistula›perineum, perineal NEC(with urethral involvement)
- Fistula›rectourethral
- Fistula›urethra
- Fistula›urethroperineal
- Fistula›urethrorectal
- Fistula›urinary(tract) (persistent) (recurrent)
Related codes at this level
Codes that share N36. If N36.0 is not quite right, the correct code is usually one of these.
Questions about N36.0
- Is N36.0 a billable ICD-10-CM code?
- Yes. N36.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does N36.0 sit in the tabular list?
- Diseases of the genitourinary system (N00-N99), in the block Other diseases of the urinary system (N30-N39).
- What cannot be coded together with N36.0?
- N36.0 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.