2025 ICD-10-CM code N36.43
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Other diseases of the urinary system - Urethral functional and muscular disorders Diseases of the genitourinary system (N00-N99) Feed
Combined hypermobility of the urethra and intrinsic sphincter deficiency.
Modifiers may be necessary to indicate the location or type of service provided depending on the clinical setting (e.g., place of service). Specific modifier application depends on the clinical context and should adhere to payer guidelines.
Medical necessity for diagnostic and treatment procedures related to N36.43 is established based on the presence of symptoms of urinary incontinence causing significant impairment of quality of life or frequent urinary tract infections.Appropriate documentation demonstrating the impact on the patient’s daily activities is needed to support medical necessity.
Urologists, gynecologists, and other healthcare professionals specializing in female pelvic medicine and reconstructive surgery may be involved in the diagnosis and management of patients with this condition.
In simple words: This code describes a condition where the urethra (the tube that carries urine from the bladder) is too loose and the muscle that helps keep urine in the bladder doesn't work properly, leading to leakage of urine.
This ICD-10-CM code classifies the combined presence of hypermobility of the urethra and intrinsic sphincter deficiency (ISD).Hypermobility refers to excessive movement or laxity of the urethra, while ISD indicates insufficient function of the internal urethral sphincter muscle responsible for maintaining urinary continence. This combination often contributes to urinary incontinence.
Example 1: A 45-year-old female patient presents with symptoms of stress urinary incontinence, including urine leakage during coughing, sneezing, or physical exertion.Physical examination reveals urethral hypermobility and urodynamic studies confirm intrinsic sphincter deficiency.Code N36.43 is assigned., A 60-year-old woman undergoes a pelvic floor examination after experiencing recurrent urinary tract infections.The examination reveals urethral hypermobility and weak urethral sphincter tone. Further testing confirms ISD. The physician documents both findings, and N36.43 is used., A 32-year-old female patient with a history of multiple vaginal deliveries complains of urinary urgency, frequency, and stress incontinence. Urodynamic evaluation confirms both urethral hypermobility and intrinsic sphincter deficiency.The clinician assigns N36.43.
Complete history and physical examination documenting symptoms of urinary incontinence (stress, urge, or mixed).Results of urodynamic studies (uroflowmetry, pressure-flow studies, electromyography) confirming urethral hypermobility and ISD.Any relevant imaging studies (ultrasound, MRI) evaluating the pelvic floor anatomy should be included.
** This code should only be used when both urethral hypermobility and intrinsic sphincter deficiency are documented.If only one of these conditions is present, the appropriate individual code (N36.41 or N36.42) should be used instead. This information is current as of December 3, 2024.Coding guidelines and regulations are subject to change.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes.
- Specialties:Urology, Gynecology, Physical Medicine and Rehabilitation
- Place of Service:Office, Hospital (inpatient and outpatient), Ambulatory Surgical Center