N36.0

N36.0: Urethral fistula

Billable / specific codeICD-10-CM

N36.0 is a billable, specific ICD-10-CM code for urethral fistula. It is valid for submission on a claim.

Check N36.0 with the rest of the claim: free scrubber

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

urethroscrotal fistula (N50.89)
urethrovaginal fistula (N82.1)
urethrovesicovaginal fistula (N82.1)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Urethroperineal fistula
Urethrorectal fistula
Urinary fistula NOS

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

N36.0 is named in 3 Medicare coverage policies: 3 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A56421Billing and Coding: CT of the Abdomen and Pelvis
A56802Billing and Coding: Urodynamics
A57455Billing and Coding: Urodynamics

Alphabetic index entries that lead here

Fistula›perineum, perineal NEC(with urethral involvement)
Fistula›rectourethral
Fistula›urethra
Fistula›urethroperineal
Fistula›urethrorectal
Fistula›urinary(tract) (persistent) (recurrent)

Code history

Unchanged in every release from FY2024 to FY2027.