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ICD-10 Guide
ICD-10 CodesN42.81

N42.81

Billable

Prostatodynia syndrome

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/18/2025

Code Description

ICD-10 N42.81 is a billable code used to indicate a diagnosis of prostatodynia syndrome.

Key Diagnostic Point:

Prostatodynia syndrome, also known as chronic pelvic pain syndrome (CPPS), is characterized by pelvic pain in men without evidence of urinary tract infection or other identifiable causes. This condition often presents with symptoms such as perineal pain, discomfort during urination, and pain during ejaculation. Prostatodynia can be associated with benign prostatic hyperplasia (BPH) and prostatitis, which are common prostate disorders that can lead to urinary symptoms and elevated prostate-specific antigen (PSA) levels. The syndrome may arise from a combination of factors including inflammation, muscle tension, and psychological stress. Diagnosis typically involves a thorough clinical evaluation, including a detailed history and physical examination, and may require ruling out other conditions through laboratory tests and imaging studies. Treatment options vary and may include medications, physical therapy, and lifestyle modifications. Understanding the nuances of prostatodynia is essential for accurate coding and effective management of the condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Overlap with other prostate disorders such as BPH and prostatitis
  • Variability in symptoms and patient presentation
  • Need for comprehensive documentation to rule out other conditions
  • Potential for misdiagnosis or underdiagnosis

Audit Risk Factors

  • Inadequate documentation of symptoms and clinical findings
  • Failure to rule out other prostate conditions
  • Misuse of related codes leading to upcoding or downcoding
  • Lack of follow-up documentation for chronic conditions

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed patient history, symptom description, physical examination findings, and results of diagnostic tests.

Common Clinical Scenarios

Patients presenting with pelvic pain, urinary frequency, and discomfort during sexual activity.

Billing Considerations

Ensure that all differential diagnoses are documented to support the use of N42.81.

Primary Care

Documentation Requirements

Comprehensive assessment of urinary symptoms, psychosocial factors, and referral notes to specialists.

Common Clinical Scenarios

Men with chronic pelvic pain who may initially present to primary care before being referred to urology.

Billing Considerations

Documenting the patient's response to initial treatments and any referrals made.

Coding Guidelines

Inclusion Criteria

Use N42.81 When
  • According to ICD
  • 10 coding guidelines, N42
  • 81 should be used when the patient presents with pelvic pain without evidence of infection or other identifiable causes
  • It is important to document the duration and severity of symptoms, as well as any treatments attempted

Exclusion Criteria

Do NOT use N42.81 When
  • Exclusion criteria include acute prostatitis and other identifiable causes of pelvic pain

Related ICD-10 Codes

Related CPT Codes

52000CPT Code

Cystoscopy

Clinical Scenario

Used when evaluating for other causes of pelvic pain.

Documentation Requirements

Indicate the reason for the procedure and findings.

Specialty Considerations

Urologists should document the findings and any interventions performed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of prostatodynia, enabling better tracking of the condition and its management. This specificity aids in research and improves patient care by allowing for tailored treatment approaches.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of prostatodynia, enabling better tracking of the condition and its management. This specificity aids in research and improves patient care by allowing for tailored treatment approaches.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of prostatodynia, enabling better tracking of the condition and its management. This specificity aids in research and improves patient care by allowing for tailored treatment approaches.

Resources

Clinical References

  • •
    American Urological Association Guidelines

Coding & Billing References

  • •
    American Urological Association Guidelines

Frequently Asked Questions

What is the primary symptom of prostatodynia syndrome?

The primary symptom of prostatodynia syndrome is chronic pelvic pain, which may be accompanied by urinary symptoms and discomfort during ejaculation.