2027 ICD-10-CM Diagnosis Code N42.1Congestion and hemorrhage of prostate

ICD-10-CM Codes›N00–N99›N40-N53›N42

ICD-10-CM N42.1
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

N42.1 is a billable ICD-10-CM diagnosis code for congestion and hemorrhage of prostate. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 729 through 730. The code is restricted by the Medicare Code Editor to adult patients (age 15 through 124). Coders also document this condition as bleeding varices of prostate. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified male genital disorders.

Code Identity

ICD-10-CM Code
N42.1
Billable Status
Yes — Valid for Submission
Code Describes
Congestion and hemorrhage of prostate
Short Description
Congestion and hemorrhage of prostate
Same as the full description in the CMS dataset.
Parent Code
N42
Other and unspecified disorders of prostate

Code Classification

ChapterN00–N99Diseases of the genitourinary system
SectionN40-N53Diseases of male genital organs
CategoryN42Other and unspecified disorders of prostate
This CodeN42.1Congestion and hemorrhage of prostate

Code EditsBilling

Medicare Code Editor checks that affect claim validity for N42.1.

Adult diagnoses
The Medicare Code Editor detects inconsistencies in adult cases by checking a patient's age and any diagnosis on the patient's record. The adult code edits apply to patients age range is 15–124 years inclusive (e.g., senile delirium, mature cataract).

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Bleeding varices of prostate
  • Congestion of prostate
  • Hematoma of prostate
  • Hemorrhage of prostate
  • Hemorrhage of prostate bed
  • Prostatic congestion or hemorrhage
  • Varicose veins of pelvis

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to N42.1: its own notes plus those printed at Chapter 14. A note printed at a category, block or chapter applies to every code under it.

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

  • enlarged prostate (N40.-)
  • hematuria (R31.-)
  • hyperplasia of prostate (N40.-)
  • inflammatory diseases of prostate (N41.-)

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From Chapter 14 (N00-N99) Diseases of the genitourinary system applies to 838 codes
  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR GEN016
Other specified male genital disorders
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Prostate Diseases

The prostate is a gland in the male reproductive system. It lies just below the bladder. It makes fluid that is part of semen.

The full article covers:

  • What is the prostate?
  • What are prostate diseases?
  • Who is more likely to develop prostate diseases?
  • What are the symptoms of prostate diseases?
  • How are prostate diseases diagnosed?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert N42.1 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
602.1 Prostatic congest/hemorr
Exact Match The mapping is direct, with no qualifiers.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About N42.1Overview

What is the ICD-10 code for congestion and hemorrhage of prostate?

The ICD-10-CM code for congestion and hemorrhage of prostate is N42.1 (sometimes written as N421). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is N42.1 (Other and unspecified disorders of prostate) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report congestion and hemorrhage of prostate on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does N42.1 group to?

When congestion and hemorrhage of prostate is the principal diagnosis on an inpatient stay, it groups to MS-DRG 729, 730, with relative weights from 0.6595 to 1.0553 depending on complications. Higher weights mean higher Medicare reimbursement.

Who can N42.1 be reported for?

The Medicare Code Editor checks congestion and hemorrhage of prostate against patient demographics: this code is intended for adult patients (age 15 through 124). Claims outside these limits are flagged as inconsistent.

Can N42.1 be reported with a code from N40?

Not as a rule. The Excludes1 note on N42.1 lists "enlarged prostate (N40.-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).