Is N42.1 a billable ICD-10-CM code?

Yes. N42.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does N42.1 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 N42.1?

N42.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

N42.1

N42.1 — Congestion and hemorrhage of prostate

Billable / specific codeICD-10-CM

N42.1 is a billable, specific ICD-10-CM code for congestion and hemorrhage of prostate. 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.

enlarged prostate (N40.-)
hematuria (R31.-)
hyperplasia of prostate (N40.-)
inflammatory diseases of prostate (N41.-)

Risk adjustment

N42.1 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.

How N42.1 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 N42.1.

Congestion, congestive›prostate(active)
Hemorrhage, hemorrhagic›prostate

Related codes at this level

Codes that share N42. If N42.1 is not quite right, the correct code is usually one of these.

Questions about N42.1

Is N42.1 a billable ICD-10-CM code?: Yes. N42.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does N42.1 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 N42.1?: N42.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.