Question 1

What is ICD-10 code N35.012?

Accepted Answer

N35.012 is the ICD-10-CM diagnosis code for post-traumatic membranous urethral stricture. Narrowing of the membranous portion of the male urethra (the narrow section passing through the prostate) resulting from previous trauma. N35.012 sits in the ICD-10-CM chapter for diseases of the genitourinary system (n00-n99), within the section covering other diseases of the urinary system (n30-n39).

N35.012 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

Membranous urethral strictures are often associated with pelvic trauma or iatrogenic injury; document the cause if known.

Question 2

Is N35.012 an HCC code?

Accepted Answer

No. N35.012 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is N35.012 billable?

Accepted Answer

Yes. N35.012 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. N35.012 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for N35.012?

Accepted Answer

N35.012 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards N35.012 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting N35.012?

Accepted Answer

Membranous urethral strictures are often associated with pelvic trauma or iatrogenic injury; document the cause if known These strictures can be complex to treat and may require referral to specialized urological centers

N35.012

Is N35.012 an HCC code?

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