2025 ICD-10-CM code N13.1
(Active) Effective Date: N/A Revision Date: N/A Diseases of the genitourinary system - Obstructive and reflux uropathy Diseases of the genitourinary system (N00-N99) Feed
Hydronephrosis with ureteral stricture, not elsewhere classified.
Modifiers may be applicable depending on the specific procedures performed.Refer to CPT and HCPCS modifier guidelines.
Medical necessity is established by the presence of hydronephrosis causing impaired kidney function or significant symptoms (e.g., pain, infection).Treatment is necessary to relieve the obstruction, preserve kidney function, and prevent complications.Documentation supporting the clinical indication for the intervention is crucial for reimbursement.
Urologist or nephrologist would typically manage this condition.The clinical responsibility involves diagnosing the underlying cause of the stricture, assessing kidney function, and determining appropriate treatment (e.g., surgery, stenting, medications).
In simple words: This code describes a kidney problem where the kidney swells because urine can't drain properly. This is due to a narrowing in the tube connecting the kidney to the bladder.
This ICD-10-CM code classifies hydronephrosis (swelling of the kidney due to urine backup) specifically caused by a ureteral stricture (narrowing of the ureter).It excludes cases with infection (N13.6),and other specified causes like calculi (N13.2) or congenital conditions.
Example 1: A 60-year-old male presents with flank pain and elevated creatinine levels.Imaging reveals hydronephrosis of the right kidney due to a stricture in the right ureter.The patient undergoes ureteroscopic incision of the stricture., A 35-year-old female with a history of pelvic inflammatory disease presents with right flank pain and hydronephrosis. Imaging shows ureteral stricture secondary to scarring.The patient is managed conservatively with medications and close monitoring., A 72-year-old male with a history of bladder cancer is found to have hydronephrosis on routine imaging.A ureteral stricture is identified as the cause of the obstruction, potentially due to tumor infiltration or prior radiation therapy. The patient requires intervention to address both the cancer and the obstruction.
Complete history and physical examination, urinalysis, blood tests (including creatinine and BUN), imaging studies (ultrasound, CT scan, intravenous pyelogram), pathology report (if surgical intervention is performed).Documentation should clearly indicate the presence of hydronephrosis and establish the ureteral stricture as the cause.
** This code should only be used when hydronephrosis is solely attributed to ureteral stricture, without other contributing factors.If other causes are present (e.g., calculi, infection), additional codes should be used.
- Payment Status: Active
- Modifier TC rule: Not applicable to this diagnosis code.
- Specialties:Urology, Nephrology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office