Is N40.1 a billable ICD-10-CM code?

Yes. N40.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does N40.1 sit in the tabular list?

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

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.

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

Risk adjustment

N40.1 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

N40.1 is named in 21 Medicare coverage policies — 21 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
A56467Billing and Coding: Laser Ablation of the Prostate
A56682Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography

How N40.1 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 N40.1.

Enlargement, enlarged›prostate›with lower urinary tract symptoms(LUTS)
Hyperplasia, hyperplastic›prostate›with lower urinary tract symptoms(LUTS)

Related codes at this level

Codes that share N40. If N40.1 is not quite right, the correct code is usually one of these.

Questions about N40.1

Is N40.1 a billable ICD-10-CM code?: Yes. N40.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does N40.1 sit in the tabular list?: Diseases of the genitourinary system (N00-N99), in the block Diseases of male genital organs (N40-N53).