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R31.0

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R31.0 - Gross Hematuria

Short Description

R31.0: Use for visible blood in the urine (gross hematuria) when the provider documents that the patient’s urine appears bloody/red/brown and the hematuria is clinically apparent to the naked eye, not just on microscopy.

Full Description & Clinical Context

R31.0 - Gross hematuria describes macroscopic hematuria, meaning there is enough blood in the urine to change its color so that it is apparent to the patient or clinician without a microscope.

Key points:

  • The urine is discolored (pink, red, tea- or cola-colored).
  • Blood is visibly present; not just RBCs on lab report.
  • Common causes include infection, stones, tumors, trauma, BPH, glomerular disease, anticoagulation, etc. (these should be coded separately when known).

Symptom vs. cause:

  • R31.0 is a symptom code.
  • When a definitive underlying condition is identified (e.g., bladder cancer, stone), the cause is coded in addition and often sequenced first, per guidelines.

R31.x Family - Variants of Hematuria

CodeDescriptionWhen to Use
R31.0Gross hematuriaVisible blood in urine (macroscopic)
R31.1Benign essential microscopic hematuriaIncidental, benign microscopic hematuria
R31.2Other microscopic hematuriaMicroscopic hematuria not specified as benign
R31.21Asymptomatic microscopic hematuriaMicroscopic hematuria without symptoms
R31.29Other microscopic hematuria“Other” forms of microscopic hematuria
R31.9Hematuria, unspecifiedHematuria, type not specified (avoid when possible)

Coding principle:

  • If documentation states gross hematuria, use R31.0.
  • If hematuria is only microscopic, use an appropriate R31.1/R31.2/R31.21/R31.29 code.
  • Avoid R31.9 when the provider clearly specifies gross or microscopic hematuria.

Coding Guidelines & Excludes Notes

From the R31 section:

  • Excludes1:
    • Hematuria included with underlying conditions, such as:
      • Acute cystitis with hematuria → N30.01
      • Recurrent and persistent hematuria in glomerular diseases → N02.-

Interpretation:

  • If the ICD-10-CM code description for the underlying disease already includes hematuria, you do not code R31.0 in addition.
  • If hematuria is a symptom of a neoplasm or other condition not already including hematuria in its title, it can be coded secondarily (e.g., malignant neoplasm of bladder + R31.0 if hematuria is the reason for visit).

Symptom coding rule:

  • If a more definitive diagnosis is established that fully explains the hematuria, that condition is usually coded first, with R31.0 coded second if still clinically relevant, per provider documentation and guideline language.

When to Use R31.0

Use R31.0 when ALL are true:

  1. Visible blood in urine is documented
    • “Gross hematuria,” “visible hematuria,” “urine appears red/bloody,” etc.
  2. Not microscopic-only
    • Do not use for RBCs seen only on urinalysis without visible color change.
  3. Hematuria not already inherent in another code title (see Excludes1).
  4. Cause is unknown OR documented but does not already include hematuria in the code description.
    • If cause is known, code it as well as R31.0, unless Excludes1 applies.

Examples where R31.0 is appropriate:

  • “Patient with gross hematuria; workup pending.”
  • “Gross hematuria likely due to stone; imaging ordered.” (stone code + R31.0).
  • “Bladder tumor with gross hematuria; presenting complaint is passing blood.” (C67.x + R31.0).

When NOT to Use R31.0

Do NOT use R31.0 when:

  • Only microscopic hematuria documented → use appropriate R31.1/R31.2/R31.21/R31.29.
  • Hematuria is already included in the underlying diagnosis code, e.g.:
    • Acute cystitis with hematuria → N30.01 (do not add R31.0).
    • Certain glomerular diseases where hematuria is inherent (e.g., N02.-).
  • Hematuria is due to menstruation-contamination or non-urinary source (documented as such).
  • “History of hematuria” only → consider history code rather than R31.0 if not current.

HCC Information

  • R31.0 is NOT an HCC code. It does not map directly to any CMS-HCC category.
  • HCC impact typically comes from the underlying condition (e.g., certain malignancies, CKD, etc.), not from R31.0 itself.

Use R31.0 mainly to support medical necessity for workup (imaging, cystoscopy, labs) and to accurately reflect the symptom driving the encounter.

RVU / wRVU Information

  • ICD-10-CM codes (including R31.0) do not carry RVUs or wRVUs.
  • RVUs apply to CPT/HCPCS procedure codes; R31.0 supports medical necessity and complexity for those services (e.g., cystoscopy, CT urogram, E/M level selection).

R31.0 can justify:

  • Advanced imaging (e.g., CT urography).
  • Endoscopic procedures (cystoscopy).
  • Lab testing (urinalysis, cytology).
  • Higher-complexity E/M when evaluation of hematuria is extensive.

Common Associated CPT Codes (Evaluation of Gross Hematuria)

Examples of CPT codes commonly associated with R31.0 (always match to documentation):

Laboratory:

  • 81001 - Urinalysis, automated with microscopy.
  • 81002 / 81003 - Urinalysis, non-automated / automated without microscopy.
  • 88112 - Cytopathology, urine (thin prep, etc.).
  • 85025 - CBC with automated differential (for anemia/infection workup).

Imaging:

  • 76770]] - Ultrasound, retroperitoneal (kidneys/bladder), complete.
  • 74178 - CT abdomen and pelvis with contrast (urogram protocol).
  • 74420 - Retrograde urography (when combined with cystoscopy).

Endoscopy (urology):

  • 52000 - Diagnostic cystoscopy.
  • 52005 - Cystoscopy with ureteral catheterization (if upper tract imaging).
  • 52204-52224 - Cystoscopy with biopsy or fulguration of lesion(s).

E/M:

  • 9920x / 9921x - Office/clinic visits (new/established).
  • 9928x - ED visits when gross hematuria is an acute presenting complaint.

Documentation Requirements for R31.0

To support R31.0, documentation should clearly show:

  • Visible blood in urine:
    • “Gross hematuria,” “visible hematuria,” “urine red/bloody,” etc.
  • Context: onset (sudden vs chronic), associated symptoms (dysuria, flank pain, clots, retention).
  • Evaluation performed: urinalysis, imaging, cystoscopy planned or completed.
  • Underlying diagnoses:
    • If a cause is known (UTI, stone, tumor, BPH), clearly document and code it.
  • Exclusions:
    • Clarify if blood could be menstrual or due to recent procedure (e.g., post-TURBT bleeding); sometimes the primary code should reflect the procedure-related state rather than R31.0.

Common pitfalls:

  • Confusing gross hematuria with microscopic hematuria and choosing the wrong R31.x code.
  • Failing to document “gross” when the patient reports visible blood.
  • Coding R31.0 but not coding the underlying cause when it is clearly known.
  • Using R31.9 (unspecified) when documentation clearly supports R31.0.

Clinical Examples

✅ Example 1 - Gross Hematuria, Cause Undetermined

“Patient presents with gross hematuria, passing bright red urine with small clots. UA shows numerous RBCs, no infection. CT urogram pending.”

  • Code: R31.0 (gross hematuria).
  • Cause not yet known - symptom coded as primary.

✅ Example 2 - Bladder Tumor with Gross Hematuria

“Patient with gross hematuria x2 weeks. Cystoscopy shows papillary tumor on posterior bladder wall.”

  • Codes:
    • C67.9 - Malignant neoplasm of bladder, unspecified.
    • R31.0 - Gross hematuria (if hematuria is a key presenting symptom/reason for visit).[web:198]

✅ Example 3 - Stone with Gross Hematuria

“Acute right flank pain and gross hematuria. CT: 6 mm right distal ureteral stone.”

  • Codes:
    • N20.1 - Calculus of ureter (or more specific as appropriate).
    • R31.0 - Gross hematuria (symptom prompting evaluation).

❌ Example 4 - Microscopic Hematuria Only

“Urine dip positive for blood, but no visible discoloration; microscopic hematuria 10-15 RBC/hpf, asymptomatic.”

  • Use R31.2/R31.21/R31.29 for microscopic hematuria, not R31.0.

Quick Coding Checklist (R31.0)

Before assigning R31.0, confirm:

  • Provider clearly documents visible blood in urine (gross hematuria).
  • Not merely microscopic hematuria (which would require an R31.1/R31.2/R31.21/R31.29 code).
  • Hematuria is not already included in another diagnosis code title (e.g., N30.01).
  • Underlying cause is coded when known, unless explicitly excluded.
  • No documentation suggesting the blood is non-urinary (e.g., vaginal source/contamination).

Quick Reference Card

ICD-10-CM R31.0 - Gross Hematuria
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
USE WHEN:
-  Visible blood in the urine (red/pink/cola-colored)
-  Provider documents “gross hematuria” or equivalent
-  Hematuria is not microscopic-only AND
-  Hematuria is not already inherent in another code’s title
 
DON’T USE WHEN:
-  Only microscopic hematuria → choose R31.1/R31.2/R31.21/R31.29
-  Code like N30.01 (acute cystitis with hematuria) already captures hematuria
-  Hematuria is due to non-urinary contamination (e.g., menstruation)
 
NOT HCC:
-  No direct HCC mapping; risk capture usually comes from the underlying cause
-  Supports medical necessity for imaging, cystoscopy, and additional workup
 
BOTTOM LINE:
R31.0 = GROSS hematuria (visible blood). 
If you can see it, it’s R31.0. 
If only the microscope can see it, use a microscopic hematuria code.

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