N36.0 ICD-10-CM Code: Urethral fistula
N36.0 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software
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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
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Urethroperineal fistula
- Urethrorectal fistula
- Urinary fistula NOS
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from N00-N99, N30-N39
- certain infectious and parasitic diseases (A00-B99)Inherited from N00-N99, N30-N39
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from N00-N99, N30-N39
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from N00-N99, N30-N39
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from N00-N99, N30-N39
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from N00-N99, N30-N39
- neoplasms (C00-D49)Inherited from N00-N99, N30-N39
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from N00-N99, N30-N39
- urinary infection (complicating):Inherited from N00-N99, N30-N39
- abortion or ectopic or molar pregnancy (O00-O07, O08.8)Inherited from N00-N99, N30-N39
- pregnancy, childbirth and the puerperium (O23.-, O75.3, O86.2-)Inherited from N00-N99, N30-N39
Related Codes
Includes
OfficialNo Includes notes are included in this display for N36.0. Check the code and parent instructions in the Code Book.
Excludes 1
Official- urethroscrotal fistula (N50.89)
- urethrovaginal fistula (N82.1)
- urethrovesicovaginal fistula (N82.1)
Code First
OfficialNo Code First sequencing instructions are included in this display for N36.0. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for N36.0. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for N36.0. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is N36.0 an HCC code?
No. N36.0 is a billable ICD-10-CM code with no mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models.
- Code
- N36.0
- Description
- Urethral fistula
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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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 the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.
Document the location and type of fistula (urethrocutaneous, urethrovaginal, etc.) when available for clinical clarity.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, 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