N40.1: Benign prostatic hyperplasia with lower urinary tract symptoms

The ICD-10-CM code for benign prostatic hyperplasia when the encounter documentation records lower urinary tract symptoms alongside the enlarged prostate.

Billable

FY2027

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At a glance

Code Family

N40: Benign prostatic hyperplasia.

HCC Mapping (v28)

No mapping. N40.1 does not fall into any CMS-HCC v28 category.

Condition

BPH with LUTS

Family Specificity

Four billable child codes split on two documented findings. The first is whether the prostate is hyperplastic or nodular. The second is whether lower urinary tract symptoms are present.

Billable

Yes

Effective Date

Valid in the FY2026 code set and unchanged in the FY2027 update.

Which N40 code do I assign?

The N40 family splits on two findings the record must state: whether the prostate is described as hyperplastic or nodular, and whether lower urinary tract symptoms are documented. Documentation that is silent on lower urinary tract symptoms directs the encounter to N40.0 rather than N40.1.

When documentation says…

Code

BPH with nocturia and a weak stream

N40.1

Benign prostatic hyperplasia with lower urinary tract symptoms. The note must name at least one obstructive or irritative symptom, such as hesitancy, weak stream, incomplete emptying, straining, frequency, nocturia, urgency or retention.

Enlarged prostate on exam, no urinary complaints

N40.0

Benign prostatic hyperplasia without lower urinary tract symptoms. This is also the default when the record says nothing about symptoms.

Nodular prostate with urinary frequency

N40.3

Nodular prostate with lower urinary tract symptoms. Nodularity documented on digital rectal examination or imaging moves the encounter out of N40.1.

Nodular prostate, asymptomatic

N40.2

Nodular prostate without lower urinary tract symptoms. The note must describe the nodularity and record no lower urinary tract symptoms.

Benign prostatic adenoma or fibroma on pathology

D29.1

Benign neoplasm of prostate. An Excludes1 note at category N40 bars reporting D29.1 together with N40.1 for the same condition. The pathology report must name the benign neoplasm.

Acute prostatitis with urinary symptoms

N41.0

Acute prostatitis. Inflammatory disease of the prostate belongs in the N41 codes rather than in category N40.

Tabular notes

USE ADDITIONAL

Use additional code for associated symptoms, when specified: incomplete bladder emptying (R39.14), nocturia (R35.1), straining on urination (R39.16), urinary frequency (R35.0), urinary hesitancy (R39.11), urinary incontinence (N39.4-), urinary obstruction (N13.8), urinary retention (R33.8), urinary urgency (R39.15) and weak urinary stream (R39.12). Assign one additional code for each symptom that is documented and addressed at the encounter. The note directs urinary incontinence to the N39.4- codes and urinary retention to R33.8.

EXCLUDES1

Benign neoplasm of prostate, including adenoma, fibroadenoma, fibroma and myoma (D29.1). An Excludes1 note means the two codes are not reported together for the same condition.

EXCLUDES2

Malignant neoplasm of prostate (C61). An Excludes2 note permits concurrent coding. A patient may have both benign prostatic hyperplasia and prostate cancer. Both N40.1 and C61 may be reported when each condition is independently documented.

FY2027: EFFECTIVE 1 OCTOBER 2026

N40.1 was valid in the FY2026 code set and is unchanged in the FY2027 update. The FY2027 codes addenda add or delete no code in category N40. The FY2027 tabular addenda change no note at N40.1 or category N40.

Operational & financial impact

Why specificity matters beyond the chart: risk adjustment, DRG assignment and denial exposure all follow from which code is selected.

CMS-HCC v28 (PY2024+)

N40.1 does not map to any Hierarchical Condition Category in CMS-HCC Model Version 28.

CMS-HCC v28 is fully operative at 100 percent weight for Medicare Advantage payment year 2026.

Reporting N40.1 contributes nothing to a beneficiary risk score. It generates no HCC credit for a Medicare Advantage plan.

V24 TO V28 TRANSITION

Benign prostatic hyperplasia was not a risk-adjusting condition under CMS-HCC v24. It is not one under v28 either.

COVERAGE CONTEXT

There is no National Coverage Determination specific to N40.1.

WHERE SPECIFICITY IS LOST

Assigning N40.0 when the note documents lower urinary tract symptoms is a coding error. N40.1 is required whenever symptoms are present.

Omitting the Use Additional codes drops the documented symptoms from the claim. The record then carries less clinical specificity than the note supports.

Assigning N40.1 when nodular prostate is documented loses the nodularity that N40.3 captures.

Documentation checklist to support N40.1

Chart elements that support code selection and reduce specificity-driven denials.

Provider documentation of benign prostatic hyperplasia, enlarged prostate or benign prostatic hypertrophy as a confirmed diagnosis.

At least one documented lower urinary tract symptom, such as hesitancy, weak stream, incomplete emptying, straining, frequency, nocturia, urgency or retention.

An explicit statement on whether lower urinary tract symptoms are present. That statement is what separates N40.1 from N40.0.

Each individual symptom named in the note, to support the Use Additional codes.

A description of the prostate as hyperplastic rather than nodular, which distinguishes N40.1 from N40.3.

A provider query where the record is ambiguous about whether lower urinary tract symptoms are present.

Where prostate cancer is also documented, independent documentation of both conditions, which is what allows N40.1 to be reported alongside C61.

For outpatient encounters, a confirmed diagnosis addressed at the visit rather than a standing problem list entry.

FAQ

Is N40.1 a billable code?

Yes. N40.1 is a billable and specific ICD-10-CM code. The parent category N40 is not billable and cannot be submitted on a claim.

When should I use N40.0 instead of N40.1?

Use N40.0 when benign prostatic hyperplasia is documented without lower urinary tract symptoms. Use N40.0 as well when the record is silent on symptoms. N40.1 requires that symptoms be documented.

Does N40.1 map to an HCC in 2026?

No. N40.1 maps to no category in CMS-HCC v28. It mapped to none in the prior v24 model either. Benign prostatic hyperplasia is not a risk-adjusting condition. Reporting N40.1 adds no weight to a beneficiary risk score.

Which lower urinary tract symptoms do I code separately?

Assign an additional code for each symptom that is documented and addressed. The tabular names incomplete bladder emptying (R39.14), nocturia (R35.1), straining on urination (R39.16), urinary frequency (R35.0), urinary hesitancy (R39.11), urinary incontinence (R32), urinary obstruction (N13.8), urinary retention (R33.9), urinary urgency (R39.15), weak urinary stream (R39.12), and dysuria (R30.0).

Can I report N40.1 together with prostate cancer?

Yes. Category N40 carries an Excludes2 note for C61. Both codes may be reported when benign prostatic hyperplasia and malignant neoplasm of the prostate are each independently documented. Sequence them by UHDDS rules, with the condition chiefly responsible for the encounter first.

How do I sequence N40.1 on an inpatient admission?

N40.1 may be the principal diagnosis for an admission driven by urinary obstruction or retention secondary to benign prostatic hyperplasia. Apply the UHDDS principal diagnosis selection rules. In the outpatient setting, sequence N40.1 first when BPH with lower urinary tract symptoms is the reason for the encounter.

What changed for N40.1 in FY2027?

N40.1 is unchanged in the FY2027 update, effective 1 October 2026. It was valid in the FY2026 code set. The FY2027 addenda add or delete no code in category N40 and change no note at N40.1.

Which N40.1 coding errors should a reviewer look for?

A reviewer should look for five errors. Assigning N40.0 when the note documents lower urinary tract symptoms. Omitting the Use Additional codes for documented symptoms. Reporting N40.1 with D29.1 for the same condition, which an Excludes1 note prohibits. Confusing benign prostatic hyperplasia with prostatitis, which belongs in the N41 codes. Assigning N40.1 when nodular prostate with symptoms is documented, which calls for N40.3.

Related codes

Codes in the same family as N40.1. Only codes with a published page render as links.

Sibling codes in the N40 family

N40.0: Benign prostatic hyperplasia without lower urinary tract symptoms.
N40.2: Nodular prostate without lower urinary tract symptoms.
N40.3: Nodular prostate with lower urinary tract symptoms.

Additional codes to consider

Codes outside the N40 family considered alongside N40.1.

Companion: code alongside when documented

R39.11: Hesitancy of micturition.
R39.12: Poor urinary stream.
R39.14: Feeling of incomplete bladder emptying.
R39.15: Urgency of urination.
R39.16: Straining to void.
R35.0: Frequency of micturition.
R35.1: Nocturia.
N39.4-: Other specified urinary incontinence, the subcategory the Use additional note names for urinary incontinence. Assign the code in it for the documented type.
R33.8: Other retention of urine.
N13.8: Other obstructive and reflux uropathy, for documented urinary obstruction.
C61: Malignant neoplasm of prostate, reportable with N40.1 under the Excludes2 note.

Consider instead

D29.1: Benign neoplasm of prostate, which an Excludes1 note bars from reporting with N40.1 for the same condition.
N41.0: Acute prostatitis.
N41.1: Chronic prostatitis.

Sources

All claims on this page derive from government and professional-standards sources.

National Center for Health Statistics. (2026). International classification of diseases, tenth revision, clinical modification (ICD-10-CM) FY2027 files. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html
Centers for Medicare & Medicaid Services and National Center for Health Statistics. (2026). ICD-10-CM official guidelines for coding and reporting FY2027. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf
Centers for Medicare & Medicaid Services. (2025). 2026 model software/ICD-10 mappings. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings
Centers for Medicare & Medicaid Services. (2026). MS-DRG classifications and software, version 44. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software