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N42 ICD-10-CM Code: Other and unspecified disorders of prostate

ICD-10-CM Code View

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FY 2026 Apr update / Diseases of the genitourinary system (N00-N99) / Diseases of male genital organs (N40-N53)

N42

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Other and unspecified disorders of prostate

Other and unspecified disorders of prostate

CMS-HCC V28

N/A

Not mapped

CMS-HCC V24

N/A

Not mapped

ACA/HHS

N/A

Not mapped

ESRD/PACE

N/A

Not mapped

RXHCC

N/A

Not mapped

Code Book Path

Official
N4Diseases of male genital organs (N40-N53)
N42Other and unspecified disorders of prostate

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for N42 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for N42 in this effective period.

Related Child Codes

Official
N42.0Calculus of prostate
N42.1Congestion and hemorrhage of prostate
N42.3Dysplasia of prostate
N42.8Other specified disorders of prostate
N42.9Disorder of prostate, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for N42 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for N42 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for N42 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for N42 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for N42 in this effective period.

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 →

Code
N42
Description
Other and unspecified disorders of prostate
HCC (V28)
No CMS-HCC V28 mapping
RAF
Billable
No
Payment year
2026

Coder workflow notes

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What This Code Means

N42 is the ICD-10-CM diagnosis code for other and unspecified disorders of prostate. N42 sits in the ICD-10-CM chapter for diseases of the genitourinary system (n00-n99), within the section covering diseases of male genital organs (n40-n53).

Header codes like N42 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at N42's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for N42 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Child Codes

Code Hierarchy

N42Other and unspecified disorders of prostate
N42Other and unspecified disorders of prostate

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