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N48.1 ICD-10-CM Code: Balanitis

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

Coding at a Glance

Tabular directives
5 Excludes1 · 1 use-additional code

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 727 — INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC (MDC 12)
  • MS-DRG 728 — INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM 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 N48.1 in the official ICD-10-CM tabular list, quoted as published.

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

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).

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code (B95-B97), to identify infectious agent

Coder workflow for N48.1

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

Before you code N48.1

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with N48.1. 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 N48.1’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.

    ReviewA06.8, N48.0, B37.42, A54.23, A60.01

Consider N48.1. 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 N48.1(5 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with N48.1: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareA06.8, N48.0, B37.42, A54.23, A60.01

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

  • Use Additional Code — after identifying N48.1(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with N48.1 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

Documentation: Both the condition N48.1 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).

ReviewA06.8, N48.0, B37.42, A54.23, A60.01

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

Coding question: Is a second code reported with N48.1?

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).

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

Balanitis is a billable ICD-10-CM diagnosis code (N48.1).

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 (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.

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 N48.1 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 3 Excludes1 notes: N47.6 — Balanoposthitis, N48.2 — Other inflammatory disorders of penis, N49 — Inflammatory disorders of male genital organs, not elsewhere classified.

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

Referenced by 11 Excludes2 notes: R10 — Abdominal and pelvic pain (via N48.-), R10-R19 — Symptoms and signs involving the digestive system and abdomen (R10-R19) (via N48.-), R11 — Nausea and vomiting (via N48.-), R12 — Heartburn (via N48.-), R13 — Aphagia and dysphagia (via N48.-), R14 — Flatulence and related conditions (via N48.-), R15 — Fecal incontinence (via N48.-), R16 — Hepatomegaly and splenomegaly, not elsewhere classified (via N48.-), R17 — Unspecified jaundice (via N48.-), R18 — Ascites (via N48.-), R19 — Other symptoms and signs involving the digestive system and abdomen (via N48.-).

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: 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 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).

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 (Inflammatory conditions of male genital organs).

N41.2 — Abscess of prostate, N41.3 — Prostatocystitis, N41.4 — Granulomatous prostatitis, N41.8 — Other inflammatory diseases of prostate, N41.9 — Inflammatory disease of prostate, unspecified, N43.1 — Infected hydrocele, N45.1 — Epididymitis, N45.2 — Orchitis, N45.3 — Epididymo-orchitis, N45.4 — Abscess of epididymis or testis, N47.6 — Balanoposthitis, N48.21 — Abscess of corpus cavernosum and penis, N48.22 — Cellulitis of corpus cavernosum and penis, N48.29 — Other inflammatory disorders of penis, N49.0 — Inflammatory disorders of seminal vesicle, N49.1 — Inflammatory disorders of spermatic cord, tunica vaginalis and vas deferens, N49.2 — Inflammatory disorders of scrotum, N49.3 — Fournier gangrene, N49.8 — Inflammatory disorders of other specified male genital organs, N49.9 — Inflammatory disorder of unspecified male genital organ, +12 more

Same Index main term, other category

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

A06.82 — Other amebic genitourinary infections (amebic), A54.23 — Gonococcal infection of other male genital organs (gonococcal), A57 — Chancroid (due to Haemophilus ducreyi), B37.42 — Candidal balanitis (candidal)

Contextual Map

Every relationship of N48.1 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 N48.1 with these 19 related codes in Claim Check

Hierarchy

Excludes1

Use Additional Code

Referenced by Excludes1 notes

Referenced by Excludes2 notes (11)

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

Index entries

  • Balanitis (circinata) (erosiva) (gangrenosa) (phagedenic) (vulgaris)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Corbus' disease (gangrenous balanitis)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (20)

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. "N48.1 — Balanitis." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/n48.1-balanitis

Change history

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

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 N48.1 in its code family, with their registry titles.

View all codes in the N48 family