N40.1

N40.1: Benign prostatic hyperplasia with lower urinary tract symptoms

Billable / specific codeICD-10-CM

N40.1 is a billable, specific ICD-10-CM code for benign prostatic hyperplasia with lower urinary tract symptoms. It is valid for submission on a claim.

Check N40.1 with the rest of the claim: free scrubber

Use additional code

Add a secondary code to capture the detail described below.

code for associated symptoms, when specified:
incomplete bladder emptying (R39.14)
nocturia (R35.1)
straining on urination (R39.16)
urinary frequency (R35.0)
urinary hesitancy (R39.11)
urinary incontinence (N39.4-)
urinary obstruction (N13.8)
urinary retention (R33.8)
urinary urgency (R39.15)
weak urinary stream (R39.12)

Inclusion terms

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

Enlarged prostate with LUTS

Excludes1 inherited from the categories above N40.1

A category’s note binds every code beneath it.

Written on N40: Benign prostatic hyperplasia

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

Excludes2 inherited from the categories above N40.1

Not part of this code, but both may be coded when both are present.

Written on N40: Benign prostatic hyperplasia

malignant neoplasm of prostate (C61)

Other codes that can never be billed with N40.1

Their own Excludes1 notes name this code, so the conflict is not listed above.

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

Risk adjustment

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

Medicare coverage

N40.1 is named in 16 Medicare coverage policies: 16 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52986Billing and Coding: Biomarkers for Oncology
A56421Billing and Coding: CT of the Abdomen and Pelvis
A56467Billing and Coding: Laser Ablation of the Prostate
A56682Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography