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Question: Can you use N13.2 if a patient has both renal and ureteral stones?

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Answer: No, you cannot use N13.2 (Hydronephrosis with renal and ureteral calculous obstruction) because the patient must also have hydronephrosis before you can use this code. Even though the term 鈥渃alculous鈥� in the descriptor for N13.2 indicates that this diagnosis code pertains to a condition involving stones, this code only applies when the stone is accompanied by hydronephrosis, a condition that causes the kidneys to swell due to urine buildup. If hydronephrosis is caused by a renal/ureteral stone that鈥檚 obstructing flow, then you鈥檒l turn to N13.2.

Remember you shouldn鈥檛 report both N13.2 and N20.0 (Calculus of kidney) when the urologist sees patients with hydronephrosis due to a kidney stone; there is an Excludes1 note following N20 that instructs you to report N13.2. If a patient has both renal and ureteral stones, you鈥檒l use N20.2 (Calculus of kidney with calculus of ureter) along with N21.1 (Calculus in urethra) to report both conditions.

Helpful tip: ICD-10-CM guideline A.12.a states an Excludes1 note is a 鈥減ure exclusion note鈥� and that you cannot code the two linked conditions together because they cannot exist together. So, if your provider documents both a condition coded to N20.- and N13.2, you would only report N13.2. Or to put it another way, per ICD-10-CM Coding Clinic Volume 5, Number 4 (2018), you should 鈥渁ssign only the code referenced in the Excludes1 note.鈥�

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC