Is N40.0 a billable ICD-10-CM code?

Yes. N40.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does N40.0 sit in the tabular list?

Diseases of the genitourinary system (N00-N99), in the block Diseases of male genital organs (N40-N53).

What cannot be coded together with N40.0?

N40.0 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above N40.0 (N40) and apply to it just the same.

N40.0

N40.0 — Benign prostatic hyperplasia without lower urinary tract symptoms

Billable / specific codeICD-10-CM

N40.0 is a billable, specific ICD-10-CM code for benign prostatic hyperplasia without lower urinary tract symptoms. It is valid for submission on a claim.

Inclusion terms

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

Enlarged prostate without LUTS
Enlarged prostate NOS

Excludes1 inherited from the categories above N40.0

These are not written on N40.0, but they bind it: a note on a category applies to every code beneath it. Billing N40.0 with anything listed here is a denial.

Written on N40 — Benign prostatic hyperplasia

benign neoplasms of prostate (adenoma, benign) (fibroadenoma) (fibroma) (myoma) (D29.1)

Excludes2 inherited from the categories above N40.0

Also inherited, and the opposite of Excludes1: these conditions are not part of N40.0, but a patient can have both, so you may code both.

Written on N40 — Benign prostatic hyperplasia

malignant neoplasm of prostate (C61)

Other codes that can never be billed with N40.0

These codes carry an Excludes1 note pointing at N40.0. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading N40.0 alone.

N42.1Congestion and hemorrhage of prostate
D29.1Benign neoplasm of prostate

Risk adjustment

N40.0 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

N40.0 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.

A52986Billing and Coding: Biomarkers for Oncology
A56421Billing and Coding: CT of the Abdomen and Pelvis
A57427Billing and Coding: Transrectal Ultrasound

How N40.0 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 N40.0.

Enlargement, enlarged›prostate
Hyperplasia, hyperplastic›prostate(adenofibromatous)
Enlargement, enlarged›prostate›without lower urinary tract symptoms(LUTS)
Hyperplasia, hyperplastic›prostate›without lower urinary tract symptoms(LUTS)

Code history

N40.0 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share N40. If N40.0 is not quite right, the correct code is usually one of these.

Questions about N40.0

Is N40.0 a billable ICD-10-CM code?: Yes. N40.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does N40.0 sit in the tabular list?: Diseases of the genitourinary system (N00-N99), in the block Diseases of male genital organs (N40-N53).
What cannot be coded together with N40.0?: N40.0 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above N40.0 (N40) and apply to it just the same.