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ICD-10 Guide
ICD-10 CodesN43.4

N43.4

Billable

Spermatocele of epididymis

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

Code Description

ICD-10 N43.4 is a billable code used to indicate a diagnosis of spermatocele of epididymis.

Key Diagnostic Point:

Spermatocele is a benign cystic formation that occurs in the epididymis, typically filled with a milky or clear fluid containing spermatozoa. These cysts are often asymptomatic and may be discovered incidentally during physical examinations or imaging studies. Spermatocele can vary in size and may cause discomfort or pain if they become large enough to exert pressure on surrounding structures. The condition is generally not associated with significant complications, but it can be a source of anxiety for patients concerned about fertility or testicular health. Diagnosis is primarily clinical, supported by ultrasound imaging to confirm the presence of a cystic structure in the epididymis. Treatment is usually not required unless the spermatocele is symptomatic, in which case surgical intervention may be considered. Understanding the implications of spermatocele is crucial in the context of male reproductive health, particularly in relation to male infertility and other testicular disorders.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other testicular masses such as hydrocele or tumors.
  • Potential overlap with other conditions like epididymitis or orchitis.
  • Variability in presentation and symptomatology.
  • Need for imaging studies to confirm diagnosis.

Audit Risk Factors

  • Inadequate documentation of symptoms or clinical findings.
  • Failure to document imaging studies that confirm diagnosis.
  • Misclassification of spermatocele as a malignant condition.
  • Lack of follow-up documentation for treatment outcomes.

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

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

Common Clinical Scenarios

Evaluation of scrotal masses, management of male infertility, and assessment of testicular pain.

Billing Considerations

Ensure clarity in distinguishing between spermatocele and other testicular conditions.

Andrology

Documentation Requirements

Comprehensive assessment of male reproductive health, including semen analysis and hormonal evaluations.

Common Clinical Scenarios

Management of male infertility and evaluation of sperm quality.

Billing Considerations

Consider the impact of spermatocele on fertility and discuss potential treatment options.

Coding Guidelines

Inclusion Criteria

Use N43.4 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the diagnosis and any associated symptoms
  • Include relevant imaging studies in the medical record to support the diagnosis of spermatocele

Exclusion Criteria

Do NOT use N43.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

55040CPT Code

Epididymectomy

Clinical Scenario

Performed when a spermatocele is symptomatic and surgical intervention is warranted.

Documentation Requirements

Operative report detailing the procedure and indication for surgery.

Specialty Considerations

Urologists should ensure clear documentation of the diagnosis and rationale for surgery.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like spermatocele, improving the accuracy of diagnoses and facilitating better patient management. It has also enhanced the ability to track epidemiological data related to male reproductive health.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like spermatocele, improving the accuracy of diagnoses and facilitating better patient management. It has also enhanced the ability to track epidemiological data related to male reproductive health.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like spermatocele, improving the accuracy of diagnoses and facilitating better patient management. It has also enhanced the ability to track epidemiological data related to male reproductive health.

Resources

Clinical References

  • •
    American Urological Association Guidelines

Coding & Billing References

  • •
    American Urological Association Guidelines

Frequently Asked Questions

What is the difference between a spermatocele and a hydrocele?

A spermatocele is a cystic structure in the epididymis filled with fluid containing sperm, while a hydrocele is a fluid collection around the testicle. They are distinct conditions with different implications for treatment and management.