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2025 ICD-10-CM code R31

Unspecified hematuria (blood in the urine).

Use this code only when hematuria is present, and the underlying cause is not known or cannot be determined, even after investigation. If the underlying cause is known, use the appropriate code for that condition, and potentially use R31 as a secondary code if needed.

Modifiers might be necessary depending on the circumstances of the procedure (if any), to provide additional information to the payer. This would require further detail about the clinical scenario.Consult your local payer guidelines.

Medical necessity for further investigation of hematuria is established based on the potential for serious underlying conditions such as bladder cancer, kidney stones, glomerulonephritis, or other urological pathologies.The absence of clear clinical indications warrants further investigation to determine the etiology and manage appropriately.

The clinical responsibility for a patient with code R31 rests with the physician managing their urinary system. This involves a thorough history and physical exam, with the need for further investigation to determine the source of the hematuria, depending on the clinical scenario.Investigations could include urinalysis, imaging studies (ultrasound, CT scan), cystoscopy, and potentially referral to a urologist.

IMPORTANT:This code should not be used if the hematuria is definitively linked to a specific condition (e.g., acute cystitis with hematuria, glomerular disease).In such cases, the appropriate code for the underlying condition should be used as the primary diagnosis, with potential supplementary codes for the hematuria if necessary.Consider using additional codes to specify the nature of the hematuria (e.g., microscopic versus macroscopic) if this information is available and relevant.

In simple words: This code means blood is found in the urine, but doctors don't yet know why.

R31, Unspecified hematuria, in the ICD-10-CM classification, denotes the presence of blood in the urine without a specified cause or associated condition.This code is used when a definitive diagnosis regarding the origin or underlying cause of the hematuria cannot be established.It encompasses instances where further investigation is needed to identify the etiology, or where the hematuria is transient and the cause remains undetermined.

Example 1: A 60-year-old male presents with painless hematuria.Urinalysis reveals microscopic hematuria. Further investigation, including ultrasound and cystoscopy, is required to rule out bladder cancer or other urological pathology. R31 is used pending further diagnostic results., A 25-year-old female experiences transient microscopic hematuria after a strenuous workout.Urinalysis shows no other abnormalities, and the hematuria resolves without treatment. In this transient case, R31 might be appropriate if no specific cause is identified., A 70-year-old female with a history of urinary tract infections is experiencing macroscopic hematuria along with dysuria.While UTI is suspected, R31 might be used as the primary code pending confirmation of the infection and complete urinalysis results, to clarify the nature and cause of the hematuria.

Detailed history of the hematuria (onset, duration, character, associated symptoms).Results of urinalysis (microscopic/macroscopic hematuria, presence of other urinary abnormalities). Results of any further investigations performed (ultrasound, CT scan, cystoscopy, biopsy results). Physician's assessment and plan for further management.

** The clinical significance of hematuria varies widely depending on factors such as age, sex, presence of symptoms, and results of further investigation.Microscopic hematuria is often asymptomatic and may resolve spontaneously, while macroscopic hematuria necessitates urgent investigation. Always consider the patient's clinical presentation when selecting the appropriate diagnosis code.

  • Payment Status: Active
  • Modifier TC rule: Not applicable; this is a diagnostic code, not a procedural code.
  • Specialties:Urology, Nephrology, Internal Medicine, Family Medicine
  • Place of Service:Office, Hospital (Inpatient or Outpatient), Urgent Care Facility, Other
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