N40 vs N42.1
N40 and N42.1 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
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
- Hemorrhage, hemorrhagic › prostate (concealed)
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