ICD-10-CM: N30.11 - Interstitial Cystitis (Chronic) with Hematuria

---
created: 2026-03-12
modified: 2026-03-12
tags:
  - icd-10
  - urology
  - cystitis
  - interstitial-cystitis
  - hematuria
  - chronic-pain
aliases:
  - Interstitial Cystitis with Hematuria
  - Hunner's Ulcer with Hematuria
  - Chronic Interstitial Cystitis with Blood
  - IC with Hematuria
code: N30.11
code_system: ICD-10-CM
code_type: Diagnosis
billable: true
effective_date: 2015-10-01
current_year: 2026
hcc_category: "None"
hcc_model: "CMS-HCC V28 (2026)"
ms_drg: "659, 660, 661, 689, 690"
chapter: "Chapter 14: Diseases of Genitourinary System (N00-N99)"
section: "N30-N39: Other Diseases of Urinary System"
parent_code: N30.1
---

Code Description

Official Long Descriptor: Interstitial cystitis (chronic) with hematuria

Clinical Definition: A chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain, ranging from mild discomfort to severe pain, specifically documented with the presence of blood in the urine. It is a component of the spectrum of diseases known as painful bladder syndrome.

Applicable To:

Chronic interstitial cystitis with hematuria
Hunner’s ulcer with hematuria
Interstitial cystitis NOS with hematuria

Laterality: This code does not specify laterality. If laterality is known, it is not captured by this specific code structure unless additional specificity is documented elsewhere in the record.

Code Hierarchy / Tree Structure

ICD-10-CM Hierarchy for N30.11

N00-N99     Diseases of the Genitourinary System
  └── N30-N39   Other Diseases of Urinary System
      └── N30       Cystitis
          ├── N30.0   Acute Cystitis
          ├── N30.1   Interstitial Cystitis (Chronic)
          │   ├── N30.10  Interstitial cystitis (chronic) without hematuria
          │   └── N30.11  Interstitial cystitis (chronic) with hematuria ← THIS CODE
          ├── N30.2   Other Chronic Cystitis
          ├── N30.3   Trigonitis
          ├── N30.4   Irradiation Cystitis
          ├── N30.8   Other Cystitis
          └── N30.9   Cystitis, Unspecified

Parent Code: N30.1 - Interstitial Cystitis (Chronic)

Code Range: N30-N39 - Other Diseases of Urinary System

Chapter: Chapter 14 - Diseases of Genitourinary System (N00-N99)

Coding Guidelines & Instructions

Use Additional Code

R31.- - Hematuria (if further specificity of hematuria is needed, though N30.11 implies it)
G89.29 - Other chronic pain (if chronic pelvic pain is documented and managed)
F41.9 - Anxiety disorder, unspecified (if associated with chronic condition)
F32.9 - Major depressive disorder, single episode, unspecified (if associated with chronic condition)

Code First (When Applicable)

Adverse Effect of Drugs: If the cystitis is due to a drug, code first the adverse effect T36-T50 with fifth or sixth character 5
Neoplasm: If associated with bladder neoplasm, code the neoplasm first

Important Coding Rules

Hematuria Specificity: The distinction between N30.10 (without hematuria) and N30.11 (with hematuria) is critical. Documentation must explicitly state the presence of blood in the urine to assign N30.11.
Chronicity: This code is for chronic interstitial cystitis. Acute cystitis should be coded to N30.0-.
Hunner’s Ulcer: If Hunner’s ulcer is documented, it falls under interstitial cystitis. Use N30.11 if hematuria is present.
Postmenopausal Atrophic Vaginitis: Do not code N30.11 if the symptoms are solely due to atrophic vaginitis N95.2.

Type 1 Excludes (Never Code Together)

Code	Description
N30.10]]	Interstitial cystitis (chronic) without hematuria
N30.0-	Acute cystitis
N34.-	Urethritis and urethral syndrome
N35.-	Urethral stricture
C67.-	Malignant neoplasm of bladder (if cystitis is due to cancer)

Note: Type 1 Excludes means “NOT CODED HERE” - these conditions cannot be coded together with N30.11 when they represent the same condition.

Type 2 Excludes (May Code Together If Both Present)

Code	Description
N30.4-	Irradiation cystitis
N30.8-	Other cystitis
N32.89	Other specified disorders of bladder
N95.2	Postmenopausal atrophic vaginitis
O86.8	Other specified puerperal infections
P39.8	Other specified infections specific to the perinatal period
T19.8	Foreign body in other and unspecified parts of urinary tract

HCC (Hierarchical Condition Category) Information

CMS-HCC Risk Adjustment Model (2026)

For CY 2026, CMS will calculate 100% of risk scores using the 2024 CMS-HCC model (V28)

HCC Category	Description	ICD-10 Codes	RAF Score Impact
None	Not a Risk Adjusting Condition	N30.11	0.00

HCC Mapping for N30.11

N30.11 does not map to a specific HCC category

Risk Adjustment Factor (RAF) Impact:

Interstitial cystitis is considered a chronic condition but does not carry a specific risk adjustment weight in the CMS-HCC V28 model.
It does not directly increase the RAF score like conditions such as Diabetes, CKD, or Heart Failure.
However, documenting associated complications (e.g., chronic pain, depression) may capture other HCCs if applicable.

2026 HCC Model Changes

Full implementation of CMS-HCC Version 28 on January 1, 2026
V28 model focuses more on severe chronic conditions
Benign urological conditions like IC remain non-HCC conditions

MS-DRG Assignments for N30.11 (MS-DRG v43.0)

MS-DRG	Description	MCC/CC Status	Relative Weight (Approx.)
659	Kidney and Urinary Tract Procedures with MCC	MCC	~2.5-3.0
660	Kidney and Urinary Tract Procedures with CC	CC	~1.5-2.0
661	Kidney and Urinary Tract Procedures without CC/MCC	None	~1.0-1.5
689	Kidney and Urinary Tract Infections with MCC	MCC	~1.8-2.2
690	Kidney and Urinary Tract Infections without MCC	None	~0.9-1.2

DRG Impact Notes

N30.11 is rarely a principal diagnosis for inpatient admission unless severe complications exist.
Most care is outpatient. If admitted for pain crisis or surgical intervention (e.g., bladder distension), DRGs 659-661 may apply.
If admitted for infection secondary to IC, DRGs 689-690 may apply.
Proper documentation of complications (CC/MCC) is essential for appropriate DRG weighting.

Diagnostic and Therapeutic Procedures

CPT Code	Description	wRVU (2026 Est.)	Est. Reimbursement	Assistant Payable
52000	Cystoscopy, including urethroscopy	3.79	~$135.00	Yes
52204	Cystourethroscopy; biopsy(s)	5.66	~$201.00	Yes
52214	Cystourethroscopy; with fulguration and/or treatment of SMALL (less than 0.5 cm) lesion(s)	7.85	~$279.00	Yes
52224	Cystourethroscopy; with fulguration and/or treatment of MEDIUM (0.5 to 2.0 cm) lesion(s)	10.50	~$373.00	Yes
52234	Cystourethroscopy; with fulguration and/or treatment of LARGE (2.0 to 5.0 cm) lesion(s)	13.20	~$469.00	Yes
52240	Cystourethroscopy; with fulguration and/or treatment of GIANT (larger than 5.0 cm) lesion(s)	16.00	~$569.00	Yes
52260	Cystourethroscopy, with distension	9.85	~$350.00	Yes
51700	Instillation of bladder medication	2.75	~$97.00	No
51701	Instillation of bladder medication (chemo)	3.50	~$124.00	No
99213	Office visit, established patient, low complexity	1.30	~$46.00	N/A
99214	Office visit, established patient, mod complexity	1.92	~$68.00	N/A
99215	Office visit, established patient, high complexity	2.90	~$103.00	N/A

Assistant Surgeon Payable Status

Cystoscopy codes (52000, 52260, etc.): Generally Assistant Payable (Status 1) under Medicare.
Instillation codes (51700): Generally NOT Assistant Payable.
E/M Codes: Not applicable for assistant surgery.
Note: Assistant payable status can vary by Medicare Administrative Contractor (MAC) and private payer policies.

Documentation Requirements

Required Documentation Elements

Chronicity: Document that the condition is chronic (lasting more than 6 weeks or recurrent).
Hematuria: Explicitly document the presence of blood in the urine to support N30.11 vs N30.10.
Symptom Severity: Document pain scores, frequency, and urgency to support medical necessity for procedures.
Treatment Response: Document response to prior therapies (e.g., oral medications, physical therapy) to justify invasive procedures like 52260.
Rule Out Malignancy: Document that bladder cancer has been ruled out if cystoscopy is performed.
Medication History: List prior medications tried (e.g., Elmiron, antihistamines, antidepressants).

Common Denial Reasons

Lack of documentation supporting chronicity
Missing documentation of hematuria for N30.11
Medical necessity not established for repeat cystoscopy
Billing 52260 without documentation of distension under anesthesia
Missing operative report for surgical procedures

Coding Examples

Example 1: Initial Diagnosis with Hematuria

Principal Diagnosis: [[N30.11]] - Interstitial cystitis (chronic) with hematuria
Secondary Diagnosis: [[R31.9]] - Hematuria, unspecified (if not inherent)
Secondary Diagnosis: [[G89.29]] - Other chronic pain

CPT: [[99214]] - Office visit, established patient
CPT: [[51700]] - Simple bladder instillation

Example 2: Cystoscopy with Hydrodistension

Principal Diagnosis: [[N30.11]] - Interstitial cystitis (chronic) with hematuria
Secondary Diagnosis: [[G89.29]] - Other chronic pain

CPT: [[52260]] - Cystourethroscopy, with distension
CPT: [[52000]] - Cystoscopy (if separate diagnostic scope done)
Note: Check NCCI edits. [[52000]] is often bundled into [[52260]].

Example 3: Fulguration of Hunner’s Ulcer

Principal Diagnosis: [[N30.11]] - Interstitial cystitis (chronic) with hematuria
Secondary Diagnosis: [[K91.89]] - Other postprocedural complications (if applicable)

CPT: [[52214]] - Cystourethroscopy with fulguration of small lesion(s)

Example 4: IC with Urinary Tract Infection

Principal Diagnosis: [[N39.0]] - Urinary tract infection, site not specified
Secondary Diagnosis: [[N30.11]] - Interstitial cystitis (chronic) with hematuria
Secondary Diagnosis: [[B96.20]] - Unspecified E. coli as the cause of diseases classified elsewhere

CPT: [[99213]] - Office visit
Note: Code infection first if that is the reason for encounter.

Common Coding Scenarios

Scenario 1: IC without Hematuria

Documentation	Correct Code	Rationale
”Interstitial cystitis, no blood in urine”	N30.10	Specific code for without hematuria exists
”Interstitial cystitis, hematuria present”	N30.11	Specific code for with hematuria
”Interstitial cystitis” (unspecified)	N30.10	Default to without hematuria if not documented

Scenario 2: Acute vs Chronic

Documentation	Correct Code	Rationale
”Acute cystitis”	N30.00 or N30.01	Acute cystitis codes
”Interstitial cystitis”	N30.10 or N30.11	Interstitial implies chronic
”Acute flare of IC”	N30.10 or N30.11	Underlying condition is still chronic IC

Scenario 3: Post-Procedure Hematuria

If hematuria is solely due to a recent procedure (e.g., catheterization):
- Do not use [[N30.11]]
- Use complication code [[T81.82]] or hematuria code [[R31.-]]
- [[N30.11]] implies the hematuria is part of the IC disease process

Quality Measures & Reporting

Measure ID	Description	Related CPT Codes
N/A	No specific CQM solely for IC	99213-99215
Pain Assessment	Documentation of Pain Assessment and Follow-Up	All E/M Codes

Required ICD-10-CM for Quality Reporting

N30.11 - Interstitial cystitis (chronic) with hematuria
G89.29 - Other chronic pain (for pain management tracking)

Billing & Reimbursement Notes

Medicare Coverage

N30.11 is a billable/specific ICD-10-CM code
Effective for dates of service on or after October 1, 2015
2026 edition effective October 1, 2025

NCCI Edit Considerations

52000 and 52260: 52000 is bundled into 52260. Do not bill separately unless distinct procedural service is documented with modifier -59.
51700 and E/M: Instillation can be billed with E/M if significant separately identifiable service is provided (Modifier -25 on E/M).
Frequency Limits: Payers may limit frequency of 52260 (e.g., once every 6 months). Check local coverage determinations (LCDs).

Modifier Requirements

Modifier	When to Use
-25	Significant, separately identifiable E/M service on same day as procedure
-59	Distinct procedural service (e.g., separate lesion or site)
-RT	Right side (if laterality applicable to procedure)
-LT	Left side (if laterality applicable to procedure)
-73	Discontinued outpatient procedure prior to anesthesia
-74	Discontinued outpatient procedure after anesthesia

Clinical Pearls

Key Clinical Facts

Interstitial Cystitis is a diagnosis of exclusion. Other causes of bladder pain must be ruled out.
Hematuria is not always present. Only code N30.11 if blood is documented.
Hunner’s Lesions: Present in a minority of IC patients but specific to the disease.
Potassium Sensitivity Test: Sometimes used for diagnosis but less common now.
Glomerulations: Petechial hemorrhages seen on distension, supportive of diagnosis.

Common Comorbidities to Document

G89.29 - Other chronic pain
F41.9 - Anxiety disorder
F32.9 - Major depressive disorder
N39.41 - Urge incontinence
R35.0 - Frequency of micturition
R35.1 - Nocturia
K59.4 - Anal pain (if pelvic floor dysfunction coexists)

Code History

Year	Effective Date	Change
2016	10/1/2015	New code (split from N30.1)
2017-2026	10/1 annually	No change

N30.11 has remained stable since ICD-10-CM implementation

Adjacent ICD-10-CM Codes

Code	Description
N30.00	Acute cystitis without hematuria
N30.01	Acute cystitis with hematuria
N30.10	Interstitial cystitis (chronic) without hematuria
N30.11	Interstitial cystitis (chronic) with hematuria
N30.20	Other chronic cystitis without hematuria
N30.21	Other chronic cystitis with hematuria
N30.30	Trigonitis without hematuria
N30.31	Trigonitis with hematuria
N30.40	Irradiation cystitis without hematuria
N30.41	Irradiation cystitis with hematuria
N30.90	Cystitis, unspecified without hematuria
N30.91	Cystitis, unspecified with hematuria

Common Associated CPT Codes

CPT	Description
52000	Cystoscopy, including urethroscopy
52260	Cystourethroscopy, with distension
51700	Instillation of bladder medication
99213	Office visit, established patient, low complexity
99214	Office visit, established patient, mod complexity
99215	Office visit, established patient, high complexity
52214	Cystourethroscopy; with fulguration (small lesion)
52224	Cystourethroscopy; with fulguration (medium lesion)

Audit Risk Areas

High-Risk Documentation Issues

Missing Hematuria Documentation: Coding N30.11 without lab or visual confirmation of blood.
Acute vs Chronic: Coding N30.11 for a first-time acute presentation without evidence of chronicity.
Bundled Services: Billing 52000 separately from 52260 without justification.
Medical Necessity: Lack of documentation supporting why invasive procedures are needed over conservative management.
Frequency: Performing 52260 too frequently without documentation of worsening symptoms.

Documentation Best Practices

Clearly state “Chronic Interstitial Cystitis” in the assessment.
Document presence or absence of hematuria explicitly.
Link pain scores to the diagnosis.
Document rule-out of infection and malignancy.
Keep a log of symptoms (frequency/volume charts) in the record.

Quick Reference Summary

Field	Value
Code	N30.11
Description	Interstitial cystitis (chronic) with hematuria
Billable	Yes
HCC Categories	None
HCC Model	CMS-HCC V28 (2026)
MS-DRGs	659, 660, 661, 689, 690
Required Additional Code	None (but consider pain codes)
Code First	Adverse effect of drugs, Neoplasm
Common CPT Codes	52260, 51700, 99214
Assistant Payable	Yes (for surgical CPTs)
Effective	10/1/2015 (current through 2026)

Explorer

N30.11