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N20.1 ICD-10-CM Code: Calculus of ureter

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

Coding at a Glance

Tabular directives
2 inclusion terms · 2 Excludes1

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.

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 N20.1 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 N20.1 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Calculus of the ureteropelvic junction
  • Ureteric stone

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 N20

Coder workflow for N20.1

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

Before you code N20.1

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with N20.1. 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 documentation support a condition named in N20.1’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.

    ReviewE83.59, N13.2

Consider N20.1. 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).

Official instructions as workflow

  • Excludes1 — check before selecting N20.1(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with N20.1: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareE83.59, N13.2

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

Coding decision scenarios

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

Documentation: Both the condition N20.1 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).

ReviewE83.59, N13.2

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

Calculus of ureter is a billable ICD-10-CM diagnosis code (N20.1).

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 (3)

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

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

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 N20.1 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 7 Excludes2 notes: N13 — Obstructive and reflux uropathy (via N20.-), N25 — Disorders resulting from impaired renal tubular function (via N20.-), N25-N29 — Other disorders of kidney and ureter (N25-N29) (via N20.-), N26 — Unspecified contracted kidney (via N20.-), N27 — Small kidney of unknown cause (via N20.-), N28 — Other disorders of kidney and ureter, not elsewhere classified (via N20.-), N29 — Other disorders of kidney and ureter in diseases classified elsewhere (via N20.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 43 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 693 (MDC 11), DRG 694 (MDC 11).

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

Clinical classification (AHRQ CCSR):GEN005 — Calculus of urinary tract (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 process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

N11.1 — Chronic obstructive pyelonephritis, N13.4 — Hydroureter, N13.5 — Crossing vessel and stricture of ureter without hydronephrosis, N13.8 — Other obstructive and reflux uropathy, N13.9 — Obstructive and reflux uropathy, unspecified, N20.0 — Calculus of kidney, N20.2 — Calculus of kidney with calculus of ureter, N20.9 — Urinary calculus, unspecified, N21.0 — Calculus in bladder, N21.1 — Calculus in urethra, N21.8 — Other lower urinary tract calculus, N21.9 — Calculus of lower urinary tract, unspecified, N28.82 — Megaloureter, N28.89 — Other specified disorders of kidney and ureter, N28.9 — Disorder of kidney and ureter, unspecified, N36.41 — Hypermobility of urethra, N36.42 — Intrinsic sphincter deficiency (ISD), N36.43 — Combined hypermobility of urethra and intrinsic sphincter deficiency, N36.8 — Other specified disorders of urethra, N36.9 — Urethral disorder, unspecified, +22 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Calculus of urinary tract).

N13.2 — Hydronephrosis with renal and ureteral calculous obstruction, N20.0 — Calculus of kidney, N20.2 — Calculus of kidney with calculus of ureter, N20.9 — Urinary calculus, unspecified, N21.0 — Calculus in bladder, N21.1 — Calculus in urethra, N21.8 — Other lower urinary tract calculus, N21.9 — Calculus of lower urinary tract, unspecified, N22 — Calculus of urinary tract in diseases classified elsewhere

Same Index main term, other category

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

K80.65 — Calculus of gallbladder and bile duct with chronic cholecystitis with obstruction (gallbladder and bile duct, with, cholecystitis, chronic, with, obstruction), K80.66 — Calculus of gallbladder and bile duct with acute and chronic cholecystitis without obstruction (gallbladder and bile duct, with, cholecystitis, chronic, with, acute cholecystitis), K80.67 — Calculus of gallbladder and bile duct with acute and chronic cholecystitis with obstruction (gallbladder and bile duct, with, cholecystitis, acute, with, chronic cholecystitis, with obstruction), K80.70 — Calculus of gallbladder and bile duct without cholecystitis without obstruction (gallbladder and bile duct), K80.71 — Calculus of gallbladder and bile duct without cholecystitis with obstruction (gallbladder and bile duct, with, obstruction), K80.80 — Other cholelithiasis without obstruction (hepatobiliary), K80.81 — Other cholelithiasis with obstruction (hepatobiliary, with obstruction), K86.89 — Other specified diseases of pancreas (pancreas), N13.2 — Hydronephrosis with renal and ureteral calculous obstruction (ureter, with hydronephrosis), N13.6 — Pyonephrosis (pyelitis, with hydronephrosis), N21.0 — Calculus in bladder (cystic), N21.1 — Calculus in urethra (urethra), N21.8 — Other lower urinary tract calculus (suburethral), N21.9 — Calculus of lower urinary tract, unspecified (urinary, lower), N28.86 — Ureteritis cystica (cystica), N28.89 — Other specified disorders of kidney and ureter, N42.0 — Calculus of prostate (prostate), N50.89 — Other specified disorders of the male genital organs (epididymis), N89.8 — Other specified noninflammatory disorders of vagina (vagina), Q38.4 — Congenital malformations of salivary glands and ducts (sublingual duct or gland, congenital), +46 more

Contextual Map

Every relationship of N20.1 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 N20.1 with these 7 related codes in Claim Check

Hierarchy

Referenced by Excludes2 notes

Clinical classification (CCSR)

MS-DRG Grouper

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
  • DRG 693 — URINARY STONES WITH MCC[MS-DRG]: “URINARY STONES WITH MCC (MDC 11)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
  • DRG 694 — URINARY STONES WITHOUT MCC[MS-DRG]: “URINARY STONES WITHOUT MCC (MDC 11)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

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

Index entries

  • Calculus, calculi, calculous, ureter (impacted) (recurrent)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Calculus, calculi, calculous, ureteropelvic junction[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Ureteritis, due to calculus[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

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. "N20.1 — Calculus of ureter." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/n20.1-calculus-of-ureter

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Calculus of ureter

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 N20.1 in its code family, with their registry titles.

View all codes in the N20 family