2025 ICD-10-CM code N13
Obstructive and reflux uropathy
Medical necessity for treatment is established by the presence of symptoms, signs, or imaging findings indicating obstructive or reflux uropathy. The documentation should support the need for intervention to prevent or address complications such as kidney damage, infection, or pain.
The physician is responsible for diagnosing the cause and severity of the obstructive or reflux uropathy. This may involve physical examination, imaging studies (such as ultrasound, CT scan, or MRI), and urodynamic testing. Treatment depends on the underlying cause and may include medication, surgery, or other interventions to relieve the obstruction or correct the reflux.
In simple words: This code refers to conditions where urine flow is blocked or flows backward from the bladder into the kidneys, potentially causing kidney swelling and other problems.
Obstructive and reflux uropathy encompasses conditions where the flow of urine is blocked or impaired, often accompanied by the backward flow of urine from the bladder into the ureters and kidneys. This can lead to various complications, including hydronephrosis (swelling of the kidney due to urine buildup), kidney damage, and infections.
Example 1: A 50-year-old male presents with flank pain and difficulty urinating. Imaging reveals a kidney stone blocking the ureter, causing hydronephrosis. This is coded as N13.2 (Hydronephrosis with renal and ureteral calculus obstruction)., A 6-year-old female has recurrent urinary tract infections. A voiding cystourethrogram (VCUG) shows vesicoureteral reflux, where urine flows back from the bladder to the kidneys. This is coded as N13.7 (Vesicoureteral reflux)., A 30-year-old female experiences symptoms of urinary frequency and urgency but no infection. Urodynamic studies demonstrate obstruction of the bladder outlet. Further investigation reveals a urethral stricture. This could be classified under N13.8 (Other obstructive and reflux uropathy) or a more specific code if available.
Documentation should include details of the patient's symptoms, relevant medical history, physical examination findings, results of imaging and urodynamic studies, and the physician's diagnosis. The specific type of obstruction or reflux should be documented, as well as any associated conditions such as hydronephrosis or infection.
** Excludes2: calculus of kidney and ureter without hydronephrosis (N20.-), congenital obstructive defects of renal pelvis and ureter (Q62.0-Q62.3), hydronephrosis with ureteropelvic junction obstruction (Q62.11), obstructive pyelonephritis (N11.1)
- Specialties:Urology, Nephrology
- Place of Service:Inpatient Hospital, On Campus-Outpatient Hospital, Office