2025 ICD-10-CM code N20.9
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the genitourinary system - Urolithiasis XIV Diseases of the genitourinary system Feed
Urinary calculus, unspecified; this code is used when the location of the urinary stone (calculus) is unknown.
Modifiers may be applicable depending on the circumstances of the encounter and the services provided. Consult the most current CPT modifier guidelines for details.
Medical necessity for coding N20.9 is established when clinical findings suggest the presence of urinary calculi, regardless of the precise location. This diagnosis necessitates evaluation and potential intervention due to the associated pain, potential for infection, and risk of urinary tract obstruction.
The clinical responsibility for coding N20.9 rests with the physician or qualified healthcare professional who diagnoses and manages the patient's urinary calculi. This includes ordering and interpreting relevant imaging studies (like x-rays or CT scans) to locate the stone and guide management decisions (such as medical expulsion therapy, ureteroscopy, or shockwave lithotripsy).
In simple words: This code means a kidney stone or other urinary stone is present, but doctors don't know exactly where in the urinary tract (kidneys, bladder, tubes connecting them) the stone is located.
This ICD-10-CM code, N20.9, signifies an unspecified urinary calculus.It is applied when a urinary stone is present, but its precise location within the urinary system (kidney, ureter, bladder, or urethra) cannot be determined.This code is inclusive of calculous pyelonephritis (kidney infection due to stones) but excludes cases with hydronephrosis (swelling of a kidney due to a blockage) coded elsewhere (N13.2). The code also excludes conditions originating in the perinatal period, infectious or parasitic diseases, complications of pregnancy and childbirth, congenital malformations, endocrine, nutritional and metabolic diseases, injuries and poisonings, neoplasms, and symptoms and signs not elsewhere classified.
Example 1: A 60-year-old male presents with severe flank pain and hematuria.Imaging studies reveal a urinary calculus, but its exact location cannot be definitively determined.N20.9 is coded., A 35-year-old female reports intermittent lower abdominal pain and urinary frequency.A non-contrast CT scan shows a urinary stone, but its precise location in the lower urinary tract is unclear, leading to the use of N20.9., A 72-year-old patient with a history of recurrent kidney stones is admitted for severe flank pain and nausea. The exact location of the stone is not fully defined via imaging studies leading to coding with N20.9.
Medical records must include details of the patient's symptoms (e.g., flank pain, hematuria, urinary frequency), findings from physical examinations, imaging reports (e.g., KUB x-ray, CT scan, ultrasound), and the physician's diagnosis of urinary calculi.If the location is unknown, the documentation should clearly state this uncertainty.
** Always ensure that the documentation supports the chosen code.In cases of uncertainty regarding the location of the urinary calculus, additional imaging studies may be necessary to determine the precise location and assign a more specific code.
- Payment Status: Active
- Modifier TC rule: Not applicable to this ICD code.
- Specialties:Urology, Nephrology, Internal Medicine, Emergency Medicine
- Place of Service:Office, Hospital (Inpatient or Outpatient), Urgent Care, Emergency Room