N30.01 - Acute Cystitis with Hematuria

Short Description

N30.01: Use for acute cystitis (acute bladder infection/UTI) when hematuria (blood in urine) is documented as PRESENT - either gross (visible) or microscopic (detected by urinalysis). This is the companion code to N30.00 (acute cystitis WITHOUT hematuria). The presence or absence of hematuria determines which code to use.

Full Description & Clinical Context

N30.01 - Acute cystitis with hematuria describes acute inflammation/infection of the urinary bladder when blood in the urine is documented as part of the clinical presentation. This represents a more complicated or severe presentation of acute cystitis compared to cases without hematuria.

Key Clinical Features:

Acute onset - sudden development of symptoms
Bladder infection/inflammation - most commonly bacterial (E. coli 75-95%)
Hematuria PRESENT - blood in urine documented (gross or microscopic)
Classic UTI symptoms - dysuria, frequency, urgency, suprapubic pain
More severe presentation - hematuria often indicates more significant infection/inflammation

Common symptoms:

dysuria - painful, burning urination
Urinary frequency - frequent need to urinate
Urgency - sudden, compelling urge to void
Suprapubic pain/discomfort - lower abdominal pain
Hematuria - blood in urine (visible or microscopic)
Cloudy or foul-smelling urine
Low-grade fever (in some cases)

Clinical significance of hematuria:

Indicates more severe bladder wall inflammation
May suggest more aggressive infection
Can be gross (visible) or microscopic (UA only)
Differentiates N30.01 from N30.00

Code Details

Code set: ICD-10-CM
Full code: N30.01
Title: Acute cystitis with hematuria
Code type: Billable/specific diagnosis code
Clinical category: Other diseases of the urinary system
Parent code: N30.0 (Acute cystitis)
Grandparent code: N30 (Cystitis)

Coding notes from N30.0 (parent):

Excludes 1:
- Irradiation cystitis → N30.4-
- Trigonitis → N30.3-

Coding notes from N30 (grandparent):

Excludes 1:
- Prostatocystitis → N41.3
Use additional code to identify infectious agent (B95-B97)
- IMPORTANT: Should add organism code when known
- Examples: B96.20 (E. coli), B95.61 (MRSA), B96.1 (Klebsiella)

N30.01 vs N30.00 (Critical Distinction!)

This is THE most important distinction for acute cystitis coding:

Code	Hematuria Status	When to Use	Documentation
N30.00	WITHOUT hematuria	No blood in urine	”No hematuria” OR hematuria not documented
N30.01	WITH hematuria	Blood in urine PRESENT	”With hematuria” OR UA shows blood ← YOU ARE HERE

Critical coding rule:

Hematuria documented (gross or microscopic) → N30.01
No hematuria documented OR “without hematuria” stated → N30.00
“Without hematuria” does NOT mean patient doesn’t have it - it means it’s not documented

Important clarification from coding discussion:

Provider documented “acute cystitis without hematuria” BUT UA shows 2+ blood
Question: Which code to use?
Answer: If UA shows blood, hematuria IS present → use N30.01
Documentation should match lab findings

Hematuria types (both use N30.01):

Gross hematuria - visible blood (urine appears pink, red, or cola-colored)
Microscopic hematuria - detected only by urinalysis (>3 RBC/hpf)
Either type = N30.01

Complete N30 Family - Cystitis Codes with Hematuria Variations

Every N30 subcategory has WITH/WITHOUT hematuria pair:

Base Code	Description	Without Hematuria	With Hematuria
N30.0	Acute cystitis	N30.00	N30.01 ← YOU ARE HERE
N30.1	Interstitial cystitis (chronic)	N30.10	N30.11
N30.2-	Other chronic cystitis	N30.20	N30.21
N30.3-	Trigonitis	N30.30	N30.31
N30.4	Irradiation cystitis	N30.40	N30.41
N30.8	Other cystitis	N30.80	N30.81
N30.9	Cystitis, unspecified	N30.90	N30.91

Coding principle:

Hematuria status determines 5th digit: 0 = without, 1 = with
Always check for hematuria documentation or UA results
Cannot assume either way without documentation

When to Use N30.01

Use N30.01 ONLY when ALL are true:

Acute cystitis diagnosed:
- Acute bladder infection/inflammation
- NOT chronic, interstitial, or other types
- Sudden onset, not longstanding
Hematuria PRESENT and documented:
- Documentation states “with hematuria” OR
- Urinalysis shows blood (gross or microscopic) OR
- Patient reports visible blood in urine
- Hematuria confirmed by provider
Not excluded conditions:
- NOT irradiation cystitis (would be N30.41)
- NOT trigonitis (would be N30.31)
- NOT prostatocystitis (would be N41.3)
Appropriate specificity:
- More specific than N30.91 (cystitis unspecified with hematuria)
- Acute, not chronic (chronic would be N30.21)

Typical scenarios for N30.01:

“35-year-old female with dysuria, frequency, urgency, and gross hematuria; UA shows numerous WBCs and RBCs; diagnosis: acute cystitis with hematuria”
“Acute UTI/cystitis with microscopic hematuria on UA”
“Acute bladder infection with blood in urine”

When NOT to Use N30.01

Do NOT use N30.01 when:

Scenario	Use Instead	Why
NO hematuria documented	N30.00	Without hematuria
Hematuria explicitly absent	N30.00	”Without hematuria”
Chronic cystitis with hematuria	N30.21	Chronic, not acute
Interstitial cystitis with hematuria	N30.11	Different type
Trigonitis with hematuria	N30.31	Excludes1 from N30.0
Irradiation cystitis with hematuria	N30.41	Excludes1 from N30.0
Prostatocystitis	N41.3	Excludes1 from N30
Pyelonephritis	N10 or N12	Kidney infection, not bladder
Urethritis	N34.x	Urethra, not bladder

Use Additional Code for Infectious Agent (CRITICAL!)

Per ICD-10-CM guidelines: Use additional code to identify infectious agent (B95-B97)

Why this matters:

Provides complete clinical picture
Identifies causative organism
Important for antibiotic stewardship
Better data for infection tracking

Common causative organisms to code (when documented/cultured):

E. coli (most common 75-95%):

B96.20 - Unspecified Escherichia coli as cause of disease
B96.21 - Shiga toxin-producing E. coli (STEC)
B96.22 - Other specified E. coli
B96.23 - Unspecified Shiga toxin-producing E. coli

Other common bacteria:

B95.61 - Methicillin susceptible Staphylococcus aureus (MSSA)
B95.62 - Methicillin resistant Staphylococcus aureus (MRSA)
B96.1 - Klebsiella pneumoniae as cause
B95.0 - Streptococcus, group A
B95.3 - Streptococcus pneumoniae
B96.89 - Other specified bacterial agents

Coding sequence:

N30.01 (acute cystitis with hematuria) - PRIMARY
B96.20 (or specific organism) - SECONDARY
Any other relevant codes

Documentation Requirements for N30.01

MINIMUM documentation needed to assign N30.01:

✅ MUST include:

“Acute cystitis” or “acute bladder infection” or “acute UTI” documented
- Acute, not chronic
- Bladder-specific (cystitis), not kidney (pyelonephritis)
Hematuria PRESENT and documented:
- “With hematuria” stated OR
- UA shows blood (RBCs present) OR
- Gross hematuria noted by patient/provider OR
- Any documentation of blood in urine
Supporting clinical evidence:
- Dysuria, frequency, urgency, suprapubic pain
- Urinalysis results (pyuria, bacteriuria, hematuria)

❌ CANNOT use if:

No hematuria documented (use N30.00)
Chronic cystitis (use N30.2x)
Other cystitis types (trigonitis, interstitial, irradiation)
Pyelonephritis (kidney infection)

✅ SHOULD document (best practice):

Specific symptoms (dysuria, frequency, urgency, pain)
Urinalysis results (WBCs, RBCs, bacteria, nitrites, leukocyte esterase)
Urine culture results (if performed)
Causative organism (if identified)
Type of hematuria (gross vs microscopic)
Treatment provided (antibiotics, analgesics)
Symptom severity

Clinical Evaluation

Typical workup for N30.01:

History:

Onset and duration of symptoms
Dysuria, frequency, urgency
Suprapubic pain/discomfort
Visible blood in urine (gross hematuria)
Prior UTIs/cystitis episodes
Sexual activity (in women)
Recent instrumentation or catheterization
Medical history (diabetes, immunosuppression)

Physical examination:

Vital signs (fever if present)
Abdominal exam (suprapubic tenderness)
Costovertebral angle tenderness (should be negative; if positive, consider pyelonephritis)
Pelvic exam (in women, if indicated)

Diagnostic studies:

Urinalysis (essential):
- Pyuria (WBCs) - usually >10 WBC/hpf
- Bacteriuria
- Hematuria (RBCs) - PRESENT for N30.01
- Nitrites (bacterial conversion)
- Leukocyte esterase (WBC marker)
- pH, protein, glucose
Urine culture (if indicated):
- Growth >100,000 CFU/mL (classic)
- Organism identification
- Antibiotic sensitivities
- Not always required for uncomplicated acute cystitis
Post-treatment culture (if symptoms persist)

Management

Typical treatment for N30.01 (acute cystitis with hematuria):

First-line antibiotics (uncomplicated):

Nitrofurantoin 100 mg BID x 5-7 days
Trimethoprim-sulfamethoxazole (Bactrim DS) BID x 3 days (if local resistance <20%)
Fosfomycin 3 g single dose

Alternative antibiotics:

Ciprofloxacin 250 mg BID x 3 days (reserve for complicated cases)
Levofloxacin 250 mg daily x 3 days
Cephalexin 500 mg BID x 5-7 days

Symptomatic relief:

Phenazopyridine (Pyridium) 200 mg TID x 2 days (urinary analgesic)
Increased fluid intake
Cranberry products (some evidence for prevention)
NSAIDs for pain

Special considerations for hematuria:

Hematuria should resolve with treatment
If hematuria persists after treatment, consider further workup
Gross hematuria may warrant imaging or cystoscopy in certain populations
Risk factors for bladder cancer (age >40, smoking, occupational exposures) may require additional evaluation

Follow-up:

Symptoms should improve within 24-48 hours
Hematuria typically resolves within days
If symptoms persist or worsen → recheck, consider culture, alternative antibiotics
Recurrent UTIs (≥2 in 6 months or ≥3 in 12 months) → prophylaxis or further workup

HCC Information

N30.01 does NOT map to a CMS-HCC - acute infections generally do not have HCC impact
No direct HCC weight or RAF score impact
Used for accurate infection documentation and treatment

Note: Chronic or complicated urinary conditions may have HCC implications, but acute cystitis (N30.01) itself does not.

RVU / wRVU Information

ICD-10-CM codes (including N30.01) do NOT carry RVUs or wRVUs
RVUs apply to CPT/HCPCS procedure codes only
N30.01 supports medical necessity for:
- Urinalysis
- Urine culture
- E/M services
- Antibiotics

Common CPT Procedure Pairings with N30.01

E/M Services:

99202-99205 - Office visit, new patient
99211-99215 - Office visit, established patient
99281-99285 - Emergency department visit

Laboratory:

81001 - Urinalysis, automated with microscopy (most common)
81002 - Urinalysis, dipstick, non-automated, without microscopy
81003 - Urinalysis, dipstick, automated, without microscopy
81015 - Urinalysis, microscopic only
87086 - Urine culture, bacterial, quantitative
87088 - Urine culture, bacterial, quantitative, with isolation and sensitivity

Procedures (if needed):

52000 - Cystourethroscopy (diagnostic) (if persistent hematuria)
52001 - Cystourethroscopy with irrigation and evacuation of clots
52005 - Cystourethroscopy with ureteral catheterization
51701 - Insertion of bladder catheter (if retention)
51702 - Insertion of temporary indwelling bladder catheter

Common Associated ICD-10-CM Codes

Often coded WITH N30.01:

Organism codes (use additional code):

B96.20 - E. coli as cause (most common)
B96.1 - Klebsiella pneumoniae
B95.61 - MSSA
B95.62 - MRSA
B96.89 - Other bacterial agents

Related urinary symptoms:

R30.0 - Dysuria
R35.0 - Frequency of micturition
R39.15 - Urgency of urination
R10.30 - Lower abdominal pain, unspecified
R31.0 - Gross hematuria (if visible blood)
R31.21 or R31.29 - Microscopic hematuria (if microscopic)

Risk factors/associated conditions:

Z87.440 - Personal history of urinary tract infections
E11.9 - Type 2 diabetes mellitus (risk factor)
N39.0 - Urinary tract infection, site not specified (less specific alternative)

Clinical Examples: When to Use N30.01

✅ Example 1 - Classic Acute Cystitis with Hematuria

SCENARIO:
35-year-old female presents with dysuria, frequency, urgency x 2 days.
Reports urine looks "pinkish."

History:
- Burning with urination
- Going every 30 minutes
- Lower abdominal discomfort
- Visible blood in urine

Exam:
- Suprapubic tenderness
- No CVA tenderness
- Afebrile

Lab:
- Urinalysis: WBC >100/hpf, RBC 50-75/hpf, bacteria 4+, 
  nitrite positive, leukocyte esterase positive
- Gross hematuria noted

Assessment: Acute cystitis with hematuria

Plan:
- Nitrofurantoin 100 mg BID x 7 days
- Phenazopyridine 200 mg TID x 2 days
- Increase fluids
- Follow-up PRN

CODES:
- N30.01 (Acute cystitis with hematuria) - PRIMARY
- B96.20 (E. coli) if culture returns positive - SECONDARY
- R30.0 (Dysuria)
- R31.0 (Gross hematuria) - optional, already in N30.01

RATIONALE:
├─ Acute cystitis diagnosis confirmed
├─ Hematuria documented (gross - visible + UA confirms)
├─ N30.01 appropriate for WITH hematuria
├─ Add organism code when culture available
└─ Supports antibiotic and UA medical necessity

✅ Example 2 - Acute Cystitis with Microscopic Hematuria Only

SCENARIO:
42-year-old female with dysuria and frequency x 3 days.
No visible blood reported by patient.

Exam:
- Suprapubic tenderness
- No fever

Lab:
- Urinalysis: WBC 25-50/hpf, RBC 15-20/hpf (microscopic hematuria),
  bacteria 3+, nitrite positive
- Patient unaware of blood in urine (microscopic only)

Assessment: Acute cystitis with microscopic hematuria

Plan:
- Bactrim DS BID x 3 days
- Increase oral fluids
- Follow-up if symptoms persist

CODE:
- N30.01 (Acute cystitis with hematuria)

RATIONALE:
├─ Acute cystitis present
├─ Hematuria documented on UA (microscopic)
├─ Even though patient didn't see blood, UA shows RBCs
├─ Microscopic hematuria = N30.01 (WITH hematuria)
└─ More specific than N30.00

❌ Example 3 - WRONG: No Hematuria Documented

SCENARIO:
Patient with acute cystitis symptoms.

Lab:
- Urinalysis: WBC 75/hpf, bacteria 4+, nitrite positive
- RBC: 0-2/hpf (NORMAL - no hematuria)

Assessment: Acute cystitis

WRONG CODE: N30.01 (with hematuria)
CORRECT CODE: N30.00 (without hematuria)

WHY:
├─ UA shows NO hematuria (RBC 0-2 is normal)
├─ N30.01 requires hematuria to be PRESENT
├─ When no hematuria documented/present → N30.00
└─ N30.01 = WITH hematuria; N30.00 = WITHOUT

KEY POINT: Check UA for RBCs before coding!

❌ Example 4 - WRONG: Documentation Says “Without” but UA Shows Blood

SCENARIO:
Provider documents: "Acute cystitis without hematuria"

BUT:
Lab results in chart: UA shows RBC 25-30/hpf (hematuria IS present)

QUESTION: Which code?

WRONG: N30.00 (following provider's statement)
CORRECT: N30.01 (hematuria IS present per UA)

WHY:
├─ Lab evidence shows hematuria IS present
├─ Documentation should match lab findings
├─ "Without hematuria" may mean provider didn't check UA yet
├─ Code based on ACTUAL findings, not initial assumption
└─ May need to query provider to clarify/amend

BEST PRACTICE: Query provider if documentation conflicts with labs

❌ Example 5 - WRONG: Chronic Cystitis, Not Acute

SCENARIO:
Patient with recurrent bladder infections for 6 months.
Currently has symptoms with hematuria.
Documentation: "Chronic cystitis with acute exacerbation and hematuria"

WRONG CODE: N30.01 (this is ACUTE cystitis)
CORRECT CODE: N30.21 (Other chronic cystitis with hematuria)

WHY:
├─ Documentation says CHRONIC cystitis
├─ N30.01 is for ACUTE (sudden onset, not chronic)
├─ Chronic with hematuria = N30.21
├─ Chronic means longstanding or recurrent
└─ Acute vs chronic distinction is critical

ALTERNATIVE: If truly acute episode of chronic condition,
code both N30.21 (chronic) primary + N30.01 secondary if appropriate,
but verify documentation supports both

❌ Example 6 - WRONG: Pyelonephritis, Not Cystitis

SCENARIO:
Patient with fever, flank pain, CVA tenderness, and dysuria.

Lab:
- UA: WBC >100/hpf, RBC 50/hpf, bacteria 4+
- Diagnosis: Acute pyelonephritis

WRONG CODE: N30.01 (cystitis)
CORRECT CODE: N10 (Acute pyelonephritis)

WHY:
├─ This is KIDNEY infection (pyelonephritis), not bladder (cystitis)
├─ CVA tenderness + fever = pyelonephritis
├─ N30.01 is for BLADDER infection only
├─ Pyelonephritis is more serious than cystitis
└─ Different organs, different codes

KEY POINT: Cystitis = bladder; Pyelonephritis = kidney

Common Documentation Errors to AVOID

❌ Error 1: Not Checking for Hematuria Status

WRONG: Coding N30.01 or N30.00 without reviewing UA
├─ Must check UA for RBCs to determine hematuria status
├─ Cannot assume either way
└─ CORRECT: Review lab results before coding

✅ CORRECT: Always check UA results for RBCs

❌ Error 2: Coding N30.00 When UA Shows Blood

WRONG: Provider says "without hematuria" but UA shows RBCs
├─ Lab evidence supersedes initial documentation
├─ May need query if discrepancy
└─ CORRECT: Code based on actual findings (N30.01 if RBCs present)

✅ CORRECT: Code matches lab evidence; query if conflict

❌ Error 3: Not Adding Organism Code

WRONG: Coding only N30.01 when organism identified
├─ Guidelines say "Use additional code for organism (B95-B97)"
├─ Should add B96.20 (E. coli) or specific organism
└─ CORRECT: N30.01 + B96.20 (when culture available)

✅ CORRECT: Add organism code when known/cultured

❌ Error 4: Confusing Acute and Chronic

WRONG: Using N30.01 for chronic/recurrent cystitis
├─ Acute = sudden onset, not longstanding
├─ Chronic/recurrent = N30.21 (with hematuria)
└─ CORRECT: N30.01 = acute; N30.21 = chronic

✅ CORRECT: Match acute vs chronic to documentation

❌ Error 5: Using for Pyelonephritis

WRONG: Coding N30.01 when diagnosis is pyelonephritis
├─ Cystitis = bladder infection
├─ Pyelonephritis = kidney infection (more serious)
└─ CORRECT: N10 for pyelonephritis, not N30.01

✅ CORRECT: Cystitis codes (N30.x) for bladder only

Compliance Checklist

Before coding N30.01, verify:

Quick Reference Card

ICD-10-CM N30.01 - Acute Cystitis with Hematuria
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
USE WHEN:
• Acute bladder infection (UTI/cystitis) diagnosed
• Hematuria PRESENT (documented gross OR microscopic on UA)
• Urinalysis shows RBCs (any amount indicates hematuria)
• Classic symptoms: dysuria, frequency, urgency, suprapubic pain
• Add organism code when known (B95-B97)
 
DON'T USE WHEN:
• No hematuria documented/present → N30.00 (WITHOUT)
• Chronic cystitis with hematuria → N30.21
• Interstitial cystitis → N30.11
• Trigonitis → N30.31
• Irradiation cystitis → N30.41
• Pyelonephritis (kidney) → N10
 
CRITICAL DISTINCTION:
• N30.01 = WITH hematuria (blood in urine present)
• N30.00 = WITHOUT hematuria (no blood documented)
• Check UA for RBCs to determine which code!
 
CODING INSTRUCTION:
• Use additional code to identify organism (B95-B97)
• Example: N30.01 + B96.20 (E. coli)
 
HEMATURIA TYPES (both use N30.01):
• Gross hematuria = visible blood (patient can see)
• Microscopic hematuria = UA shows RBCs (patient can't see)
 
NOT HCC:
• No direct HCC mapping
• Used for infection documentation and treatment
 
COMPANION CODE:
• You already have N30.00 (WITHOUT hematuria) in your vault
• These are paired codes - WITH vs WITHOUT hematuria
 
BOTTOM LINE:
N30.01 = acute bladder infection WITH hematuria (blood in urine).
Check UA for RBCs. Add organism code when known.
Companion to N30.00 (without hematuria).

Last Updated: February 9, 2026
For coding reference only - always verify against the current ICD-10-CM, official guidelines, payer policies, and facility rules.
Key concept: N30.01 is for acute cystitis (bladder infection) when hematuria (blood in urine) is PRESENT, either gross (visible) or microscopic (detected on UA). This is the companion code to N30.00 (without hematuria). Always check urinalysis results for RBCs to determine which code to use. Per coding guidelines, use additional code to identify infectious agent (B95-B97) when organism is known.
The presence or absence of hematuria is THE critical distinction between N30.01 and N30.00.

Explorer

N30.01