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v1.0.0
ICD-10 Guide
ICD-10 CodesN43.0

N43.0

Billable

Encysted hydrocele

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

Code Description

ICD-10 N43.0 is a billable code used to indicate a diagnosis of encysted hydrocele.

Key Diagnostic Point:

Encysted hydrocele is a type of hydrocele characterized by the accumulation of serous fluid within a sac-like structure surrounding the testis. This condition typically arises from a failure of the processus vaginalis to close, leading to the formation of a cyst that can vary in size. Patients may present with a painless swelling in the scrotum, which can be transilluminated to confirm the presence of fluid. While encysted hydroceles are generally benign, they can sometimes be associated with underlying testicular disorders, such as orchitis or trauma. In some cases, they may contribute to male infertility due to pressure effects on the testis or associated conditions. Diagnosis is primarily clinical, supported by ultrasound imaging to assess the nature of the fluid and rule out other pathologies. Treatment options include observation for asymptomatic cases or surgical intervention for symptomatic patients or those desiring fertility. Proper management is crucial to prevent complications and ensure reproductive health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other types of hydroceles and testicular masses
  • Potential association with other male reproductive disorders
  • Variability in presentation and symptoms among patients
  • Need for imaging studies to confirm diagnosis

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to include imaging results in the medical record
  • Misdiagnosis due to overlapping symptoms with other conditions
  • Lack of clear treatment plans or follow-up notes

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed history of symptoms, physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Evaluation of scrotal swelling, management of male infertility, and post-operative follow-up after hydrocele repair.

Billing Considerations

Ensure accurate documentation of the size and characteristics of the hydrocele, as well as any associated conditions.

Andrology

Documentation Requirements

Assessment of male reproductive health, including fertility evaluations and hormonal assessments.

Common Clinical Scenarios

Infertility workup in males, management of testicular pain, and counseling regarding reproductive options.

Billing Considerations

Document any impact of the hydrocele on fertility and the patient's reproductive goals.

Coding Guidelines

Inclusion Criteria

Use N43.0 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include any relevant imaging studies and treatment plans

Exclusion Criteria

Do NOT use N43.0 When
  • Exclude conditions that do not meet the criteria for encysted hydrocele

Related ICD-10 Codes

Related CPT Codes

55040CPT Code

Hydrocelectomy

Clinical Scenario

Performed for symptomatic encysted hydrocele.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Urologists should document the size and characteristics of the hydrocele.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of encysted hydrocele, improving the accuracy of data collection and reimbursement processes. It emphasizes the need for detailed documentation to support the diagnosis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of encysted hydrocele, improving the accuracy of data collection and reimbursement processes. It emphasizes the need for detailed documentation to support the diagnosis.

Reimbursement & Billing Impact

reimbursement processes. It emphasizes the need for detailed documentation to support the diagnosis.

Resources

Clinical References

  • •
    American Urological Association Guidelines

Coding & Billing References

  • •
    American Urological Association Guidelines

Frequently Asked Questions

What is the difference between an encysted hydrocele and a regular hydrocele?

An encysted hydrocele is a specific type of hydrocele where fluid is contained within a sac, often due to developmental issues, while a regular hydrocele may not have this encapsulation and can be more diffuse.