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N13.9 ICD-10-CM Code: Obstructive and reflux uropathy, unspecified

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
2 inclusion terms · 1 Excludes1 · 4 Excludes2

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 698 — OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC (MDC 11)
  • MS-DRG 699 — OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC (MDC 11)
  • MS-DRG 700 — OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC (MDC 11)
  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for N13.9 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on N13.9 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • pyelonephritis

Source: inherited from N10-N16

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Urinary tract obstruction NOS

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from N10-N16

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from N13

Coder workflow for N13.9

MedCoder structured workflow — derived from this code’s own official record

Before you code N13.9

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, N13.9 may be the appropriate code. Check the record for detail that supports a more specific sibling — in this subcategory the siblings differ by the presence or absence of the associated condition. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    ReviewN13.0, N13.1, N13.2, N13.4, N13.5, N13.6, N13.7, N13.8

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with N13.9. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — N13.9 is appropriate when the documentation goes no further.

    ReviewN13.0, N13.1, N13.2, N13.4, N13.5, N13.6, N13.7, N13.8

  2. Does the documentation support a condition named in N13.9’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewN28.85

Consider N13.9. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting N13.9(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with N13.9: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareN28.85

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of N13.9(4 notes)

    Coding workflow: The conditions named in this note are not included in N13.9. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareN20, Q62.11, N11.1

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the specific siblings in this subcategory and what each requires the record to state.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

ReviewN13.0, N13.1, N13.2, N13.4, N13.5, N13.6, N13.7, N13.8

Documentation: Both the condition N13.9 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewN28.85

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Obstructive and reflux uropathy, unspecified is a billable ICD-10-CM diagnosis code (N13.9).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (5)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name N13.9 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: N11.1 — Chronic obstructive pyelonephritis (via N13.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 3 Code Also instructions: N80.A4 — Superficial endometriosis of ureter (via N13.-), N80.A5 — Deep endometriosis of ureter (via N13.-), N80.A6 — Endometriosis of ureter, unspecified depth (via N13.-).

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 5 MS-DRGs: DRG 698 (MDC 11), DRG 699 (MDC 11), DRG 700 (MDC 11), DRG 791 (MDC 15), DRG 793 (MDC 15).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):GEN006 — Other specified and unspecified diseases of kidney and ureters (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Other specified and unspecified diseases of kidney and ureters).

A18.11 — Tuberculosis of kidney and ureter, A54.21 — Gonococcal infection of kidney and ureter, N13.0 — Hydronephrosis with ureteropelvic junction obstruction, N13.1 — Hydronephrosis with ureteral stricture, not elsewhere classified, N13.2 — Hydronephrosis with renal and ureteral calculous obstruction, N13.30 — Unspecified hydronephrosis, N13.39 — Other hydronephrosis, N13.4 — Hydroureter, N13.5 — Crossing vessel and stricture of ureter without hydronephrosis, N13.8 — Other obstructive and reflux uropathy, N23 — Unspecified renal colic, N25.0 — Renal osteodystrophy, N25.1 — Nephrogenic diabetes insipidus, N25.81 — Secondary hyperparathyroidism of renal origin, N25.89 — Other disorders resulting from impaired renal tubular function, N25.9 — Disorder resulting from impaired renal tubular function, unspecified, N26.1 — Atrophy of kidney (terminal), N26.2 — Page kidney, N27.0 — Small kidney, unilateral, N27.1 — Small kidney, bilateral, +16 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Obstruction, obstructed, obstructive”, “Uropathy”; these codes share that main term but sit in a different category of the Tabular List.

K80.21 — Calculus of gallbladder without cholecystitis with obstruction (cystic duct, with calculus), K80.51 — Calculus of bile duct without cholangitis or cholecystitis with obstruction (bile duct or passage, with calculus), K82.0 — Obstruction of gallbladder (gallbladder), K83.1 — Obstruction of bile duct (biliary), K86.89 — Other specified diseases of pancreas (pancreatic duct), K90.2 — Blind loop syndrome, not elsewhere classified (lacteal, with steatorrhea), K91.30 — Postprocedural intestinal obstruction, unspecified as to partial versus complete (intestine, postoperative), K91.31 — Postprocedural partial intestinal obstruction (intestine, postoperative, partial), K91.32 — Postprocedural complete intestinal obstruction (intestine, postoperative, complete), N11.1 — Chronic obstructive pyelonephritis (pyelonephritis), N28.0 — Ischemia and infarction of kidney (artery, renal), N28.89 — Other specified disorders of kidney and ureter (renal), N32.0 — Bladder-neck obstruction (vesical NEC), N36.8 — Other specified disorders of urethra (urethra NEC), N39.9 — Disorder of urinary system, unspecified, N50.89 — Other specified disorders of the male genital organs (ejaculatory duct), N85.8 — Other specified noninflammatory disorders of uterus (uterus), N89.5 — Stricture and atresia of vagina (vagina), N97.1 — Female infertility of tubal origin (fallopian tube), P76.0 — Meconium plug syndrome (meconium, newborn), +97 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Prostate-Specific Antigen (PSA)

Contextual Map

Every relationship of N13.9 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run N13.9 with these 4 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Code Also instructions

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 11 — Diseases and Disorders of the Kidney and Urinary Tract[MDC crossing]: “Diseases and Disorders of the Kidney and Urinary Tract — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 3,574 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
  • MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Obstruction, obstructed, obstructive, urinary (moderate)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Obstruction, obstructed, obstructive, urinary (moderate), organ or tract (lower)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Obstruction, obstructed, obstructive, uropathy[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Uropathy, obstructive[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Uropathy, reflux[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (22)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "N13.9 — Obstructive and reflux uropathy, unspecified." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/n13.9-obstructive-and-reflux-uropathy-unspecified

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Obstructive and reflux uropathy, unspecified

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to N13.9 in its code family, with their registry titles.

View all codes in the N13 family