2025 ICD-10-CM code N20.1
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Urological - Urolithiasis XIV Diseases of the genitourinary system Feed
Calculus of ureter; presence of a stone in the ureter.
Modifiers may apply to procedural codes used in the management of N20.1 but not directly to N20.1 itself.Specific modifier usage depends on the procedure and clinical circumstances.
Medical necessity for treatment of N20.1 is established by the presence of significant symptoms (e.g., intractable pain, urinary obstruction, infection, or renal damage) or the potential for complications.The choice of treatment depends on stone size, location, and patient’s clinical presentation.
The clinical responsibility for managing a patient with N20.1 includes diagnosis via imaging (X-ray, CT scan, ultrasound), assessment of symptoms (pain, hematuria), and treatment which may include observation, medication, lithotripsy, ureteroscopy, or surgery depending on the size and location of the stone and patient’s condition.
In simple words: This code means you have a kidney stone in your ureter, the tube that carries urine from your kidney to your bladder.
N20.1, Calculus of ureter, in the ICD-10-CM classification system, denotes the presence of a calculus (stone) within the ureter.This code is used to classify cases of ureteral stones regardless of size, composition, or the presence of associated symptoms.It includes cases of ureteric stone.This code excludes nephrocalcinosis (E83.59) and cases with hydronephrosis (N13.2).
Example 1: A 45-year-old male presents with severe flank pain radiating to the groin, nausea, and microscopic hematuria. Imaging reveals a 5mm ureteral stone.The patient undergoes ureteroscopic stone removal., A 60-year-old female with a history of recurrent kidney stones experiences mild flank pain and intermittent hematuria. Imaging shows a small (3mm) ureteral stone.The patient is managed conservatively with increased fluid intake and pain medication; the stone passes spontaneously., A 32-year-old male with a history of hypercalciuria develops a large (10mm) obstructing ureteral stone causing severe hydronephrosis and renal colic. He undergoes extracorporeal shock wave lithotripsy (ESWL) to fragment the stone.
Detailed history, physical examination, imaging studies (e.g., KUB, CT scan, ultrasound), laboratory results (e.g., urinalysis, blood chemistry), and documentation of treatment rendered.
** Further sub-classification might be needed based on other details of the case.Always refer to the latest version of the ICD-10-CM manual for accurate coding.
- Revenue Code: Revenue codes will vary depending on the services provided and payer.
- RVU: RVUs are not applicable to ICD-10 codes.RVUs are associated with CPT codes and are used for physician reimbursement.
- Global Days : Not applicable to ICD-10 codes.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10-CM codes.
- Fee Schedule : Not applicable to ICD-10-CM codes.
- Specialties:Urology, Nephrology
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center, Emergency Room