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N40.1 ICD-10-CM Code: Benign prostatic hyperplasia with lower urinary tract symptoms

Compare with another codeCheck this code on a claim

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

Coding at a Glance

Tabular directives
8 inclusion terms · 1 Excludes1 · 1 Excludes2 · 11 use-additional codes

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too; the Instructions section marks which is which.

Use additional codeReport with this code when documented
  • code for associated symptoms, when specified:
  • incomplete bladder emptying (R39.14)
  • nocturia (R35.1)
  • straining on urination (R39.16)

+7 more in Instructions

Excludes1Never report with this code
  • benign neoplasms of prostate (adenoma, benign) (fibroadenoma) (fibroma) (myoma) (D29.1)
Excludes2Not included here; may be reported together
  • malignant neoplasm of prostate (C61)
IncludesWhat this code covers
  • adenofibromatous hypertrophy of prostate
  • benign hypertrophy of the prostate
  • benign prostatic hypertrophy
  • BPH

+4 more in Instructions

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

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 v44, Appendix B.

  • MS-DRG 725 — BENIGN PROSTATIC HYPERTROPHY WITH MCC (MDC 12)
  • MS-DRG 726 — BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC (MDC 12)

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 N40.1 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on N40.1 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.

  • adenofibromatous hypertrophy of prostate
  • benign hypertrophy of the prostate
  • benign prostatic hypertrophy
  • BPH
  • enlarged prostate
  • nodular prostate
  • polyp of prostate

Source: inherited from N40

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Enlarged prostate with LUTS

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 N40

Excludes2 — Not Included Here

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

Source: inherited from N40

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code for associated symptoms, when specified:
  • incomplete bladder emptying (R39.14)
  • nocturia (R35.1)
  • straining on urination (R39.16)
  • urinary frequency (R35.0)
  • urinary hesitancy (R39.11)
  • urinary incontinence (N39.4-)
  • urinary obstruction (N13.8)
  • urinary retention (R33.8)
  • urinary urgency (R39.15)
  • weak urinary stream (R39.12)

Coder workflow for N40.1

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

Before you code N40.1

  1. N40.1’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with N40.1. 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 N40.1’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.

    ReviewD29.1

Consider N40.1. Then work the Use Additional Code note, and 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).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Excludes1 — check before selecting N40.1(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with N40.1: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareD29.1

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

  • Excludes2 — not part of N40.1(1 note)

    Coding workflow: The conditions named in this note are not included in N40.1. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareC61

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

  • Use Additional Code — after identifying N40.1(11 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with N40.1 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewR39.14, R35.1, R39.16, R35.0, R39.11, N39.4

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

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

Documentation: Both the condition N40.1 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).

ReviewD29.1

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is N40.1 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with N40.1?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewR39.14, R35.1, R39.16, R35.0, R39.11, N39.4

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.

Don’t confuse N40.1 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of N40.1 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • D29.1— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of benign neoplasms of prostate (adenoma, benign) (fibroadenoma) (fibroma) (myoma) moves the case to D29.1; the two are not reported together unless documented as unrelated.

    Full comparison: N40.1 vs D29.1 →

  • C61— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of malignant neoplasm of prostate adds C61; it is not part of this code and both may be reported when both are documented.

    Full comparison: N40.1 vs C61 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Benign prostatic hyperplasia with lower urinary tract symptoms is a billable ICD-10-CM diagnosis code (N40.1).

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

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. 11 Use Additional Code instructions — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  2. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  3. 1 Excludes2 entry — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • Age-restricted: the Medicare Code Editor lists this as an adult (age 15-124) diagnosis; other ages are presumed incorrect.

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-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name N40.1 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 2 Excludes1 notes across 2 chapters: D29.1 — Benign neoplasm of prostate (via N40.-), N42.1 — Congestion and hemorrhage of prostate (via N40.-).

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

Referenced by 4 Code First instructions across 2 chapters: N13.8 — Other obstructive and reflux uropathy, R33.8 — Other retention of urine, R35 — Polyuria, R39.1 — Other difficulties with micturition.

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 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 2 MS-DRGs: DRG 725 (MDC 12), DRG 726 (MDC 12).

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

Clinical classification (AHRQ CCSR):GEN012 — Hyperplasia of prostate (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 (Hyperplasia of prostate).

N40.0 — Benign prostatic hyperplasia without lower urinary tract symptoms, N40.2 — Nodular prostate without lower urinary tract symptoms, N40.3 — Nodular prostate with lower urinary tract symptoms

Same Index main term, other category

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

K38.0 — Hyperplasia of appendix (appendix), K76.89 — Other specified diseases of liver (liver, nodular, focal), L85.9 — Epidermal thickening, unspecified (epithelial), M26.01 — Maxillary hyperplasia (jaw, upper), M26.03 — Mandibular hyperplasia (jaw, lower), M26.09 — Other specified anomalies of jaw size (jaw), M26.71 — Alveolar maxillary hyperplasia (jaw, upper, alveolar), M26.72 — Alveolar mandibular hyperplasia (jaw, lower, alveolar), M26.79 — Other specified alveolar anomalies (jaw, alveolar), M27.8 — Other specified diseases of jaws (unilateral condylar), N50.89 — Other specified disorders of the male genital organs (genital, male), N60.9 — Unspecified benign mammary dysplasia (breast, atypical, atypia), N62 — Hypertrophy of breast (epithelial, nipple), N72 — Inflammatory disease of cervix uteri (endocervicitis), N83.8 — Other noninflammatory disorders of ovary, fallopian tube and broad ligament (ovary), N85.00 — Endometrial hyperplasia, unspecified (endometrium, endometrial), N85.01 — Benign endometrial hyperplasia (endometrium, endometrial, benign), N85.02 — Endometrial intraepithelial neoplasia [EIN] (endometrium, endometrial, with atypia), N85.2 — Hypertrophy of uterus (uterus), N89.3 — Dysplasia of vagina, unspecified (epithelial, vaginal wall), +48 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 N40.1 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 N40.1 with these 12 related codes in Claim Check

Hierarchy

Use Additional Code (10)

Referenced by Excludes1 notes

Referenced by Code First instructions

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 12 — Diseases and Disorders of the Male Reproductive System[MDC crossing]: “Diseases and Disorders of the Male Reproductive System — 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. 1,969 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Enlargement, enlarged, prostate, with lower urinary tract symptoms (LUTS)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Hyperplasia, hyperplastic, prostate (adenofibromatous), with lower urinary tract symptoms (LUTS)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes

Change history (3)

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Indexed Clinical Terms (2)

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.

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 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 — v44 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-derived 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 editorial 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 20, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

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. "N40.1 — Benign prostatic hyperplasia with lower urinary tract symptoms." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/n40.1-benign-prostatic-hyperplasia-with-lower-urinary-tract-symptoms

Change history

  • FY2017 — October 1, 2016
    Description revised
    Enlarged prostate with lower urinary tract symptoms → Benign prostatic hyperplasia with lower urinary tract symptoms
    FY2017 changes
  • FY2017 — October 1, 2016
    Short description revised
    Enlarged prostate with lower urinary tract symptoms → Benign prostatic hyperplasia with lower urinary tract symp
    FY2017 changes
  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Enlarged prostate with lower urinary tract symptoms

Nearest Codes in This Family

Official ICD-10-CM classifications closest to N40.1 in its code family, with their registry titles.

View all codes in the N40 family