Crystal's Coder Hub🧬 ICD-10-CM N13.5 — Crossing Vessel and Stricture of Ureter Without Hydronephrosis
Billable Code Confirmed
ICD-10 CM N13.5 is a valid, billable 5-character ICD-10-CM code for FY2026. Characters 1-3 (N13) identify the category (obstructive and reflux uropathy); character 4 specifies the subcategory; character 5 specifies the crossing vessel/stricture subtype without hydronephrosis as the terminal specificity axis. No further character extension is available or required — this is a fully specified, terminal code.
Non-Billable Parent Codes — Never Submit These
- ❌
N13— 3-character header — missing specificity of obstruction type and presence/absence of hydronephrosisAlways submit N13.5 (all 5 characters) when a crossing vessel and/or ureteral stricture is documented without associated hydronephrosis.
Clinical Context: " Without Hydronephrosis" Is the Critical Specificity Axis
ICD-10-CM N13.5 specifically captures the scenario where a crossing vessel (typically an aberrant lower-pole renal artery) or ureteral stricture creates obstruction at or near the ureteropelvic junction, but imaging does not demonstrate hydronephrosis at the time of the encounter. This is clinically important because many patients with crossing vessel UPJ obstruction have intermittent or positional obstruction that may not produce persistent hydronephrosis on all imaging studies. If hydronephrosis is present, the code shifts to N13.0 (hydronephrosis with UPJ obstruction) or N13.1 (hydronephrosis with ureteral stricture), depending on the mechanism — do not assign N13.5 when hydronephrosis is documented.
Code Classification
ICD-10 CM Diagnosis Code — wRVU, global surgical period, and assistant-at-surgery fields are not applicable to this diagnosis code. For associated inpatient procedures, refer to the ICD-10-PCS Crosswalk section. For profee billing context, refer to the Commonly Associated CPT Codes section.
🔍 Code Description
ICD-10 CM N13.5 classifies crossing vessel and stricture of ureter without hydronephrosis, capturing acquired mechanical obstruction of the ureter due to an extrinsic crossing vascular structure (most commonly an aberrant lower-pole renal artery or vein) or an intrinsic ureteral stricture, in the absence of documented hydronephrosis (collecting system dilation) on imaging. This code exists as a distinct billable entity because the obstructive mechanism — whether vascular compression or fibrotic stricture — has clear surgical management implications (pyeloplasty, endopyelotomy, ureteral dilation) that differ from calculus-related or congenital obstruction.
The pathophysiologic mechanism of a crossing vessel involves an aberrant lower-pole renal artery (or, less commonly, a vein) that drapes anterior to the ureter at the ureteropelvic junction, creating extrinsic compression and intermittent or positional obstruction to urine flow. In adults, crossing vessels account for the majority of acquired UPJ obstruction cases and are identifiable on CT urography or laparoscopic inspection. The “without hydronephrosis” qualifier indicates that, despite the obstructive anatomy, compensatory drainage is sufficient to prevent collecting system dilation at the time of evaluation — often seen in early or intermittent obstruction.
🌳 Code Tree / Hierarchy
N13 Obstructive and reflux uropathy ❌ Non-billable (3-char header)
│
├── N13.0 Hydronephrosis with ureteropelvic junction obstruction ✅ Billable
├── N13.1 Hydronephrosis with ureteral stricture, not elsewhere classified ✅ Billable
├── N13.2 Hydronephrosis with renal and ureteral calculous obstruction ✅ Billable
│
├── N13.3 Other and unspecified hydronephrosis ❌ Non-billable
│ │
│ ├── N13.30 Unspecified hydronephrosis ✅ Billable
│ └── N13.39 Other hydronephrosis ✅ Billable
│
├── N13.4 Hydroureter ✅ Billable
├── N13.5 Crossing vessel and stricture of ureter without hydronephrosis ◀ THIS CODE ✅ Billable
├── N13.6 Pyonephrosis ✅ Billable
│
├── N13.7 Vesicoureteral-reflux ❌ Non-billable
│ │
│ ├── N13.70 Vesicoureteral-reflux, unspecified ✅ Billable
│ ├── N13.71 Vesicoureteral-reflux without reflux nephropathy ✅ Billable
│ ├── N13.72 Vesicoureteral-reflux with reflux nephropathy without hydroureter ❌ Non-billable
│ │ ├── N13.721 ...unilateral ✅ Billable
│ │ └── N13.722 ...bilateral ✅ Billable
│ └── N13.73 Vesicoureteral-reflux with reflux nephropathy with hydroureter ❌ Non-billable
│ ├── N13.731 ...unilateral ✅ Billable
│ └── N13.732 ...bilateral ✅ Billable
│
└── N13.8 Other obstructive and reflux uropathy ✅ Billable
N13.9 Obstructive and reflux uropathy, unspecified ✅ Billable
N13.5 vs. N13.0 — Imaging Timing Matters
A patient with a crossing vessel may be coded N13.0 (hydronephrosis with UPJ obstruction) or N13.5 depending on whether imaging demonstrates hydronephrosis at the time of the encounter. It is not uncommon for the same patient to carry different codes across encounters — N13.5 during a diagnostic workup where a MAG-3 renal scan confirms obstruction but CT shows no hydronephrosis, and N13.0 if a follow-up CT shows new collecting system dilation. Code the condition as documented per the current encounter’s imaging and clinical findings.
✅ Includes
The following clinical terms and scenarios map to N13.5 when documented:
- Crossing renal vessel (lower-pole artery or vein) compressing the ureter at the UPJ, confirmed on CT urography or diagnostic laparoscopy, with no hydronephrosis on imaging
- Acquired ureteral stricture (non-calculous, non-congenital) documented without hydronephrosis
- Intermittent UPJ obstruction due to vascular compression without persistent collecting system dilation
- Ureteral kinking from aberrant vessel at the renal hilum, no documented hydronephrosis
- Functional obstruction documented by nuclear medicine renal scan (MAG-3 with diuresis showing obstruction) in the absence of hydronephrosis on anatomic imaging
❌ Excludes
Excludes 2 — May Be Coded in Addition if Separately Present
| Code | Description | Note |
|---|---|---|
| N20.- | Calculus of kidney and ureter without hydronephrosis | If calculus is simultaneously present but not causing hydronephrosis, both N13.5 and the relevant N20 code may be reported — they are not mutually exclusive |
| Q62.0-Q62.3 | Congenital obstructive defects of renal pelvis and ureter | N13.5 is for acquired crossing vessel/stricture; when a patient has BOTH a known congenital anomaly AND an acquired crossing vessel, the Q62 congenital code may be reported separately |
| Q62.11 | Hydronephrosis with ureteropelvic junction obstruction (congenital) | Congenital UPJ obstruction with hydronephrosis — separate from N13.5; may coexist with acquired crossing vessel in complex cases |
| N11.1 | Chronic obstructive pyelonephritis | If the patient has a chronic infectious nephritis component in addition to the crossing vessel obstruction, N11.1 may be separately coded |
Key Clarification — No Excludes 1 Violations
Unlike many other N13 subcategory codes, N13.5 does not carry Excludes 1 restrictions against the listed codes — these are all Excludes 2 notes, meaning you may code the additional conditions separately when clinically present and documented. However, never assign N13.5 alongside N13.0 or N13.1 for the same anatomic site — if hydronephrosis develops, the code upgrades and N13.5 is no longer appropriate for that scenario.
📋 Clinical Overview
Crossing Vessel Obstruction vs. Intrinsic Stricture — Code Selection Nuance
N13.5 covers two distinct obstructive mechanisms that share the same code — an important distinction for CDI and documentation clarity even though the code is the same.
| Feature | Crossing Vessel Mechanism | Intrinsic Ureteral Stricture Mechanism |
|---|---|---|
| Pathophysiology | Extrinsic vascular compression of ureter at UPJ by aberrant lower-pole renal vessel | Fibrotic narrowing of ureteral lumen due to prior surgery, radiation, infection, or ischemia |
| Common Etiology | Aberrant lower-pole renal artery (adult predominant); less commonly a vein | Post-ureteroscopy scarring, radiation-induced fibrosis, prior ureteral injury |
| Imaging Finding | CT urography shows vessel crossing anterior to ureter; MAG-3 may show obstruction without hydronephrosis | CT urography shows focal ureteral narrowing; ureteroscopy shows mucosal scarring |
| Surgical Management | Laparoscopic dismembered pyeloplasty (CPT 50544) with vessel transposition | Endoscopic dilation (CPT 52344), endopyelotomy (CPT 50575), or open/laparoscopic ureteral repair |
| ICD-10-CM Code | N13.5 — without hydronephrosis | N13.5 — without hydronephrosis (same code, document mechanism) |
| If Hydronephrosis Present | **N13.0 | N13.1** |
CDI Query Trigger — Differentiate Crossing Vessel from Intrinsic Stricture
When operative reports or imaging describe both a crossing vessel and a concurrent ureteral stricture at the same site, query the urologist to clarify the primary obstructive mechanism documented. Both are captured under N13.5 when hydronephrosis is absent, but documentation specificity about mechanism (vascular compression vs. stricture) supports clinical data integrity, surgical coding accuracy, and quality reporting. For payers conducting prior authorization for pyeloplasty vs. dilation, mechanism documentation may influence medical necessity review.
Manifestations & Symptom Burden
Common clinical presentations and manifestations documented alongside N13.5:
- Flank or loin pain: Intermittent colicky flank pain, often worsened with high fluid intake (Dietl’s crisis) — a classic presentation of positional crossing vessel obstruction
- Recurrent UTIs: Urinary stasis from partial obstruction predisposes to ascending infection — code separately N39.0 if documented
- Hematuria: Gross or microscopic hematuria from urothelial irritation — code R31.0 (gross) or R31.9 (microscopic) separately if documented
- Nausea/vomiting: Associated with renal colic episodes — integral symptom, not separately coded when due to the obstruction
- Hypertension secondary to renal compression: If renovascular hypertension is documented as a consequence, code I15.0 separately
Coding Manifestations
Always code the documented complications and associated conditions to fully capture patient complexity:
💰 HCC Risk Adjustment (CMS-HCC v28)
| Field | Detail |
|---|---|
| CMS-HCC Model Version | v28 (Fully implemented PY2026) |
| HCC Assignment | ❌ Not HCC-Mapped |
| HCC Category | N/A |
| RAF Coefficient | N/A |
N13.5 does not map to any HCC category under CMS-HCC v28 and does not independently contribute to RAF scoring.
Indirect HCC Relevance
While N13.5 itself is not HCC-mapped, complications arising from longstanding ureteral obstruction — such as chronic kidney disease (HCC 137-138) or acute kidney failure (HCC 135) — are HCC-mapped and should be captured separately when documented by the provider. If the obstructive uropathy has progressed to CKD, document and code the CKD stage (N18.1-N18.5) in addition to N13.5 at every qualifying encounter to ensure proper RAF capture for the downstream complication.
🏥 MS-DRG Assignment
MDC 11 — Diseases and Disorders of the Kidney and Urinary Tract
| DRG | Title | Est. Relative Weight* |
|---|---|---|
| DRG 698 | Other Kidney and Urinary Tract Diagnoses with MCC | ~1.10-1.40 |
| DRG 699 | Other Kidney and Urinary Tract Diagnoses with CC | ~0.80-1.00 |
| DRG 700 | Other Kidney and Urinary Tract Diagnoses without CC/MCC | ~0.55-0.70 |
If an inpatient O.R. procedure (e.g., laparoscopic pyeloplasty) is performed, the case shifts to a surgical DRG:
| DRG | Title | Est. Relative Weight* |
|---|---|---|
| DRG 673 | Other Kidney and Urinary Tract Procedures with MCC | ~3.50-4.50 |
| DRG 674 | Other Kidney and Urinary Tract Procedures with CC | ~2.00-2.80 |
| DRG 675 | Other Kidney and Urinary Tract Procedures without CC/MCC | ~1.40-1.80 |
Approximate. Verify against IPPS FY2026 Final Rule Table 5 and your facility’s cost-to-charge ratios.
Sequencing and CC/MCC Optimization
N13.5 itself is not a CC or MCC when sequenced as a secondary diagnosis. Its DRG impact is primarily as a principal diagnosis driver — it determines the MDC 11 medical grouping tier. The DRG tier (698 vs. 699 vs. 700) is entirely driven by secondary diagnosis CC/MCC burden. Capture all documented secondary conditions — particularly acute kidney injury (N17.9 — MCC), urinary tract infection (N39.0 — may be CC), and sepsis (A41.9 — MCC) — to appropriately maximize DRG tier. When a laparoscopic or open pyeloplasty is performed, the case becomes surgical and relative weight increases substantially (DRG 673-675).
🔗 Related ICD-10-CM Codes
N13 Category — Obstruction Type and Hydronephrosis Status
| Code | Description |
|---|---|
| N13.5 | Crossing vessel and stricture of ureter without hydronephrosis ← This Code |
| N13.0 | Hydronephrosis with ureteropelvic junction obstruction |
| N13.1 | Hydronephrosis with ureteral stricture, not elsewhere classified |
| N13.2 | Hydronephrosis with renal and ureteral calculous obstruction |
| N13.30 | Unspecified hydronephrosis |
| N13.4 | Hydroureter |
| N13.6 | Pyonephrosis |
| N13.8 | Other obstructive and reflux uropathy |
Congenital UPJ Obstruction (Excludes 2 — May Coexist)
| Code | Description |
|---|---|
| Q62.11 | Hydronephrosis with ureteropelvic junction obstruction (congenital) |
| Q62.0 | Congenital hydronephrosis |
| Q62.2 | Congenital obstruction of ureter |
Related Renal Complications
| Code | Description |
|---|---|
| N17.9 | Acute kidney failure, unspecified (MCC — commonly associated with bilateral obstruction or solitary kidney) |
| N18.3 | Chronic kidney disease, stage 3 (moderate) |
| N39.0 | Urinary tract infection, site not specified |
| N20.1 | Calculus of ureter (may coexist per Excludes 2) |
🛠️ Commonly Associated CPT Codes (Urology)
Outpatient, Ambulatory Surgery, and Inpatient Setting Context
N13.5 commonly drives surgical procedures in the outpatient ambulatory or inpatient setting. Laparoscopic/robotic pyeloplasty (50544) is the gold-standard surgical treatment for crossing vessel UPJ obstruction. Endoscopic ureteral stricture treatments (52341, 52344) are associated when the obstruction is stricture-mediated rather than purely vascular. Diagnostic workup typically involves CT urography and nuclear renal scan (MAG-3).
| CPT Code | Description | Profee Coding Notes |
|---|---|---|
| 50544 | Laparoscopy, surgical; pyeloplasty | Primary surgical CPT for crossing vessel UPJ repair — includes laparoscopic/robotic dismembered pyeloplasty with vessel transposition; no separate code for robotic assistance (use 50544 for laparoscopic/robotic) |
| 50400 | Pyeloplasty (Foley Y-pyeloplasty or other type), with or without plastic operation on renal pelvis | Open pyeloplasty — less common in adults; document approach clearly |
| 50405 | Pyeloplasty (Foley Y-pyeloplasty or other type), with or without plastic operation on renal pelvis; complicated (secondary operation, horseshoe kidney, etc.) | Open pyeloplasty, complicated — use when secondary/revision procedure or anatomic complexity |
| 52341 | Cystourethroscopy; with treatment of ureteral stricture (balloon dilation, laser, electrocautery, incision) | Endoscopic treatment of ureteral stricture component — less commonly associated with crossing vessel mechanism specifically |
| 52344 | Cystourethroscopy with ureteroscopy; with treatment of ureteral stricture | More comprehensive than 52341 — includes ureteroscopic visualization; use when ureteroscope is advanced to the stricture site |
| 50575 | Renal endoscopy through nephrotomy or pyelotomy; with endopyelotomy | Antegrade endopyelotomy — approach through percutaneous access; less common than 50544 for crossing vessel cases |
| 52332 | Cystourethroscopy, with insertion of indwelling ureteral stent | Stent placement — commonly performed at end of pyeloplasty or endoscopic repair; bundled into 50544 if performed during same surgical session |
| 74178 | CT urography, with and without contrast | Diagnostic imaging CPT — commonly paired pre-operatively with N13.5 |
| 78708 | Kidney imaging morphology, with vascular flow and function, with or without single gland comparison | Nuclear MAG-3 renal scan — key diagnostic study confirming functional obstruction in N13.5 cases |
NCCI Bundling Considerations
- Ureteral stent insertion (52332 52332) billed on the same date as pyeloplasty (50544) is bundled — stent insertion is integral to the pyeloplasty; do not separately report 52332 with 50544 without a valid modifier exception.
- Diagnostic ureteroscopy (52351) performed during the same operative session as a therapeutic ureteroscopic procedure (52344) is bundled — report only the higher-level therapeutic CPT.
- E/M (99213-99215) 99213 billed on the same date as a minor urologic procedure (e.g., stent removal) requires Modifier -25 on the E/M to establish a separately identifiable and documented medical decision-making service beyond the procedure itself.
🔬 ICD-10-PCS Crosswalk (Inpatient Procedures)
When N13.5 is an inpatient diagnosis, these PCS codes are relevant for associated inpatient procedures.
| PCS Section | Body System | Root Operation | Clinical Application |
|---|---|---|---|
| 0 (Medical and Surgical) | T (Urinary System) | Q (Repair) | Laparoscopic pyeloplasty — 0TQ44ZZ (Right, Percutaneous Endoscopic) or 0TQ54ZZ (Left, Percutaneous Endoscopic); open approach: 0TQ40ZZ / 0TQ50ZZ |
| 0 (Medical and Surgical) | T (Urinary System) | 7 (Dilation) | Endoscopic ureteral stricture dilation — 0T747ZZ (Right Ureter, Natural/Artificial Opening Endoscopic) or 0T757ZZ (Left Ureter) |
| 0 (Medical and Surgical) | T (Urinary System) | H (Insertion) | Ureteral stent placement post-repair — 0TH97DZ (indwelling ureteral stent insertion via endoscopic approach) |
| 0 (Medical and Surgical) | T (Urinary System) | 9 (Drainage) | Percutaneous nephrostomy placement for temporary decompression — 0T930ZZ (Drainage of Right Kidney, Percutaneous) |
💊 Coding Scenarios and Examples
Scenario 1 — Outpatient/Surgical: Laparoscopic Pyeloplasty for Crossing Vessel UPJ Obstruction
Clinical Vignette: A 34-year-old male presents with a 2-year history of intermittent right flank pain, worse after large fluid intake. CT urography reveals a crossing lower-pole renal artery anterior to the right ureter at the UPJ without hydronephrosis. MAG-3 diuretic renogram confirms right-sided obstructive pattern (T½ > 20 minutes). No hydronephrosis on CT. Urologist documents: “Right crossing vessel with UPJ obstruction, no hydronephrosis — proceeding with laparoscopic dismembered right pyeloplasty with vessel transposition.”
CPT (Profee):
- 50544 — Laparoscopy, surgical; pyeloplasty (primary surgical CPT — laparoscopic/robotic dismembered pyeloplasty)
ICD-10-CM Principal Diagnosis:
- N13.5 — Crossing vessel and stricture of ureter without hydronephrosis (primary indication for surgery)
Secondary Diagnoses:
- M54.41 — Lumbago with sciatica, right side — (do not code; flank pain is integral to N13.5 — not separately reportable)
- (Code any documented comorbidities separately — UTI, hypertension, etc.)
Scenario 2 — Inpatient: Ureteral Stricture-Mediated Obstruction with AKI
Clinical Vignette: A 58-year-old female with a history of prior left ureteroscopy for stones presents with worsening left flank pain and elevated creatinine (2.8 from baseline 1.0). CT urography shows left ureteral narrowing at the mid-ureter without hydronephrosis; urology documents “acquired left ureteral stricture without hydronephrosis, likely post-instrumentation, with superimposed acute kidney injury.” Patient is admitted for IV hydration, nephrology consult, and ureteral stent placement.
Principal Diagnosis:
- N13.5 — Crossing vessel and stricture of ureter without hydronephrosis (reason for admission — specifically ureteral stricture component)
Secondary Diagnoses:
- N17.9 — Acute kidney injury, unspecified (MCC — drives DRG 698; document clearly in final diagnoses)
- Z87.442 — Personal history of urinary calculi (relevant history)
MS-DRG Assignment: With N13.5 as PDx and N17.9 as MCC secondary, case groups to DRG 698 (Other Kidney and Urinary Tract Diagnoses with MCC) — highest-weighted medical tier in this DRG family.
Scenario 3 — CDI Query: Hydronephrosis vs. No Hydronephrosis Documentation Gap
Clinical Vignette: A 45-year-old female presents with right flank pain. Imaging report reads: “Crossing right lower-pole renal artery; mild fullness of the right renal pelvis; no definitive hydronephrosis.” The urologist’s assessment documents “right UPJ obstruction due to crossing vessel” without addressing the hydronephrosis question. The coder cannot determine whether to assign N13.5 (without hydronephrosis) or N13.0 (with UPJ obstruction, implying possible hydronephrosis).
Action / Outcome: The “mild fullness” on the radiology report is ambiguous — it may represent early/borderline hydronephrosis or normal variant. The provider’s note does not reconcile the imaging findings. A CDI query is required to clarify whether hydronephrosis is present or absent per the clinical assessment.
Query Response: Urologist updates the final diagnosis to: “Right crossing vessel UPJ obstruction without hydronephrosis — mild renal pelvic fullness is not consistent with hydronephrosis per clinical review.”
Corrected ICD-10-CM Coding:
- N13.5 — Crossing vessel and stricture of ureter without hydronephrosis (now confirmed: no hydronephrosis present)
- (If provider had confirmed hydronephrosis instead: N13.0 would be correct)
⚠️ Coding Pitfalls and Tips
| Pitfall or Tip | |
|---|---|
| ❌ | Assigning N13.5 When Hydronephrosis Is Present. If imaging documents any degree of hydronephrosis (collecting system dilation), N13.5 is incorrect. Use N13.0 (hydronephrosis with UPJ obstruction/crossing vessel) or N13.1 (hydronephrosis with ureteral stricture). N13.5 is specifically and exclusively for cases where hydronephrosis is absent on imaging. |
| ❌ | Coding N13.5 for Congenital UPJ Obstruction. N13.5 is for acquired crossing vessel or ureteral stricture. Congenital UPJ anomalies belong in the Q62 category (e.g., Q62.11, Q62.2). In pediatric patients especially, verify whether the obstruction is congenital or acquired before assigning N13.5. |
| ❌ | Using the Non-Billable Parent Code N13 or N13.0 Incorrectly. N13 (3-character) is non-billable — always select the appropriate 5th-character code. N13.0 implies hydronephrosis with UPJ obstruction; do not default to N13.0 when hydronephrosis is absent just because it appears more clinically familiar. |
| ❌ | Separately Coding Flank Pain or Renal Colic with N13.5. Pain symptoms integral to the obstructive uropathy (flank pain, loin pain, Dietl’s crisis) are not separately reportable — they are clinically subsumed by N13.5 per Official Coding Guidelines. |
| ✅ | Always Query When Hydronephrosis Status Is Ambiguous. Terms like “mild pelvic fullness,” “borderline dilation,” or “slight prominence of the collecting system” are not synonymous with hydronephrosis. Query the responsible provider to clarify before selecting N13.5 vs. N13.0 or N13.1. |
| ✅ | Capture AKI as MCC When Present. Acute kidney injury (N17.9) is a frequent secondary diagnosis with ureteral obstruction and functions as an MCC, shifting DRG from 700 → 698. Always verify creatinine trends and provider documentation of AKI before finalizing the record. |
| ✅ | Code the Underlying Etiology When Known. If the crossing vessel obstruction is documented as due to a specific anatomic variant or prior surgery, code any related secondary diagnoses (e.g., prior procedure history via Z codes, CKD from chronic obstruction) to capture full complexity. |
| ✅ | Verify Laterality in Operative and Imaging Reports. While N13.5 itself has no laterality character, laterality is captured in the associated ICD-10-PCS codes (Right vs. Left Ureter/Kidney Pelvis) during inpatient encounters. Ensure the operative report and imaging are concordant for correct PCS code assignment. |
📚 Sources
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CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2026. Section I.C.14 — Diseases of the genitourinary system; Excludes 2 conventions and note interpretation. ^[1]
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CMS. IPPS Final Rule FY2026 — MS-DRG Definitions Manual v43.0/v43.1. MDC 11 logic tables; DRG 673-675, 693-700 definitions and relative weights. Table 5 FR FY2026 relative weight file. ^[2]
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AAPC Codify. ICD-10 Code N13.5 — Crossing vessel and stricture of ureter without hydronephrosis. Code description, Excludes 2 notes, and clinical mapping. Retrieved May 2026. ^[3]
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icdlist.com. 2026 ICD-10-CM Diagnosis Code N13.5 — Crossing vessel and stricture of ureter without hydronephrosis. Billability confirmation and code hierarchy. ^[4]
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Unbound Medicine / ICD-10-CM 2026. N13.5 — Crossing Vessel and Stricture of Ureter Without Hydronephrosis. Official code citation, CMS/NCHS 10th ed. ^[5]
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DC Urology / Urologic Surgeons of Washington. “Ureteropelvic Junction (UPJ) Obstruction.” Clinical description of crossing vessel mechanism; aberrant lower-pole renal artery pathophysiology. ^[6]
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PMC / Journal of Urology (Sampaio, 2006). “UPJ Obstruction in the Adult Population: Are Crossing Vessels Relevant?” PMC1476031. Functional assessment of crossing vessels as etiology of UPJ obstruction. ^[7]
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PMC (2021). “Crossing Vessels with Suspension versus Transposition in Laparoscopic Pyeloplasty.” PMC8101153. Surgical technique comparison for crossing vessel management. ^[8]
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CMS. Revised CMS-HCC Model v28 Relative Factor Tables. Confirmation that N13.5 is not mapped to an HCC category under CMS-HCC v28 for PY2026. ^[9]
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Johns Hopkins Medicine. “Laparoscopic Pyeloplasty.” Clinical overview of pyeloplasty indications, technique, and outcomes for UPJ obstruction. ^[10]
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Cleveland Clinic. “Pyeloplasty: Purpose, Procedure, Risks & Recovery.” Clinical overview of open and laparoscopic pyeloplasty for UPJ obstruction. ^[11]
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PRS Network / AAPC. “CPT Code for Ureteroscopy — 52341, 52344, 52351, 52356.” NCCI bundling guidance and CPT descriptor review for ureteroscopic ureteral procedures. ^[12]