N36.0 ICD-10-CM Code: Urethral fistula
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the genitourinary system (N00-N99) / Other diseases of the urinary system (N30-N39)
N36.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUrethral fistula
An abnormal opening or tunnel in the urethra that allows urine to leak into surrounding tissues or to the skin surface.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
Official- Urethroperineal fistula
- Urethrorectal fistula
- Urinary fistula NOS
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for N36.0 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for N36.0 in this effective period.
Excludes 1
Official- urethroscrotal fistula (N50.89)
- urethrovaginal fistula (N82.1)
- urethrovesicovaginal fistula (N82.1)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for N36.0 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for N36.0 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for N36.0 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is N36.0 an HCC code?
No. N36.0 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
N36.0 is the ICD-10-CM diagnosis code for urethral fistula. An abnormal opening or tunnel in the urethra that allows urine to leak into surrounding tissues or to the skin surface. N36.0 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).
N36.0 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.
Document the location and type of fistula (urethrocutaneous, urethrovaginal, etc.) when available for clinical clarity.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for N36.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the location and type of fistula (urethrocutaneous, urethrovaginal, etc.) when available for clinical clarity
- •Distinguish from urethral diverticulum (N36.1), which is a pouch rather than a fistula tract