N43.1 ICD-10-CM Code: Infected hydrocele

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for N43.1 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 N43.1 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for N43.1

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

Before you code N43.1

1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with N43.1. 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 N43.1’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.

   ReviewP83.5

Consider N43.1. 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 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 N43.1(1 note)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with N43.1: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareP83.5

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

• Use Additional Code — after identifying N43.1(1 note)

  Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with N43.1 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

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

Coding decision scenarios

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

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.

Indexed Clinical Terms (1)

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.

• Hydrocele (spermatic cord) (testis) (tunica vaginalis), infected

Don’t confuse N43.1 with…

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

The codes most likely to be picked instead of N43.1 — 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.

• P83.5— 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 congenital hydrocele moves the case to P83.5; the two are not reported together unless documented as unrelated.

  Full comparison: N43.1 vs P83.5 →

• N43.3— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Hydrocele, unspecified” takes N43.3; specificity in the record moves it back here.

  Full comparison: N43.1 vs N43.3 →

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.

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

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 10 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 727 (MDC 12), DRG 728 (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):GEN013 — Inflammatory conditions of male genital organs (default); GEN016 — Other specified male genital disorders.

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.

A59.00 — Urogenital trichomoniasis, unspecified, A59.8 — Trichomoniasis of other sites, A59.9 — Trichomoniasis, unspecified, B37.41 — Candidal cystitis and urethritis, B37.42 — Candidal balanitis, B37.49 — Other urogenital candidiasis, N43.0 — Encysted hydrocele, N43.2 — Other hydrocele, N43.3 — Hydrocele, unspecified

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Inflammatory conditions of male genital organs, Other specified male genital disorders).

N42.30 — Unspecified dysplasia of prostate, N42.31 — Prostatic intraepithelial neoplasia, N42.32 — Atypical small acinar proliferation of prostate, N42.39 — Other dysplasia of prostate, N42.81 — Prostatodynia syndrome, N42.82 — Prostatosis syndrome, N42.83 — Cyst of prostate, N42.89 — Other specified disorders of prostate, N42.9 — Disorder of prostate, unspecified, N43.0 — Encysted hydrocele, N43.2 — Other hydrocele, N43.3 — Hydrocele, unspecified, N43.40 — Spermatocele of epididymis, unspecified, N43.41 — Spermatocele of epididymis, single, N43.42 — Spermatocele of epididymis, multiple, N44.00 — Torsion of testis, unspecified, N44.01 — Extravaginal torsion of spermatic cord, N44.02 — Intravaginal torsion of spermatic cord, N44.03 — Torsion of appendix testis, N44.04 — Torsion of appendix epididymis, +77 more

Same Index main term, other category

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

N90.89 — Other specified noninflammatory disorders of vulva and perineum (vulva), N94.89 — Other specified conditions associated with female genital organs and menstrual cycle (female NEC), P83.5 — Congenital hydrocele (newborn)

Contextual Map

Every relationship of N43.1 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 N43.1 with these 3 related codes in Claim Check

Hierarchy

• N00-N99 — Chapter 14: Diseases of the Genitourinary System (N00-N99) (N00-N99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N40-N53 — Diseases of male genital organs[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Use Additional Code

• B95 — Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere[Use Additional Code]: “code (B95-B97), to identify infectious agent”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• B96 — Other bacterial agents as the cause of diseases classified elsewhere[Use Additional Code]: “code (B95-B97), to identify infectious agent”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• B97 — Viral agents as the cause of diseases classified elsewhere[Use Additional Code]: “code (B95-B97), to identify infectious agent”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• GEN013 — Inflammatory conditions of male genital organs[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
• GEN016 — Other specified male genital disorders[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

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 727 — INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC[MS-DRG]: “INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC (MDC 12)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 728 — INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC[MS-DRG]: “INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC (MDC 12)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

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. 1,964 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Hydrocele (spermatic cord) (testis) (tunica vaginalis), infected[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

• N43 — Hydrocele and spermatocele[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N43.0 — Encysted hydrocele[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N43.2 — Other hydrocele[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N43.3 — Hydrocele, unspecified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N43.4 — Spermatocele of epididymis[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N43.40 — Spermatocele of epididymis, unspecified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N43.41 — Spermatocele of epididymis, single[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• N43.42 — Spermatocele of epididymis, multiple[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

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

Nearest Codes in This Family

Official ICD-10-CM classifications closest to N43.1 in its code family, with their registry titles.

• N43 — Hydrocele and spermatocele
• N43.0 — Encysted hydrocele
• N43.2 — Other hydrocele
• N43.3 — Hydrocele, unspecified
• N43.4 — Spermatocele of epididymis
• N43.40 — Spermatocele of epididymis, unspecified
• N43.41 — Spermatocele of epididymis, single
• N43.42 — Spermatocele of epididymis, multiple

View all codes in the N43 family