FY2027
MenuClose
Excludes1 pair

N40- vs N42.1

N40 and N42.1 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.

The official note, declared on N42.1
enlarged prostate (N40.-)
N40

Benign prostatic hyperplasia

Not billable
Chapter 14
Diseases of the genitourinary system
Section
N40-N53
Use when the record says
  • adenofibromatous hypertrophy of prostate
  • benign hypertrophy of the prostate
  • benign prostatic hypertrophy
  • BPH
  • enlarged prostate
  • nodular prostate
  • polyp of prostate
N42.1

Congestion and hemorrhage of prostate

Billable
Chapter 14
Diseases of the genitourinary system
Section
N40-N53
Indexed under
  • Congestion, congestive › prostate (active)
  • Hemorrhage, hemorrhagic › prostate

Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027