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ICD-10 Guide
ICD-10 CodesN43.40

N43.40

Billable

Spermatocele of epididymis, unspecified

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

Code Description

ICD-10 N43.40 is a billable code used to indicate a diagnosis of spermatocele of epididymis, unspecified.

Key Diagnostic Point:

Spermatocele is a benign cystic formation that occurs in the epididymis, typically filled with a clear or milky fluid containing sperm. It is often asymptomatic and may be discovered incidentally during a physical examination or imaging studies. The condition arises from the obstruction of the epididymal duct, leading to the accumulation of fluid. While spermatoceles are generally harmless, they can sometimes cause discomfort or pain, particularly if they grow large. Diagnosis is usually confirmed through physical examination and ultrasound imaging, which helps differentiate a spermatocele from other testicular masses such as hydroceles or tumors. Treatment is not typically required unless the spermatocele causes significant discomfort or complications, in which case surgical intervention may be considered. Understanding the implications of a spermatocele is essential in the context of male reproductive health, as it can be associated with other conditions affecting fertility, such as orchitis or testicular torsion. Proper management and follow-up are crucial to ensure that any underlying issues are addressed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other testicular disorders such as hydrocele and tumors.
  • Potential association with male infertility issues.
  • Variability in clinical presentation and symptoms.
  • Need for imaging studies for accurate diagnosis.

Audit Risk Factors

  • Inadequate documentation of symptoms or clinical findings.
  • Failure to differentiate between spermatocele and other testicular masses.
  • Lack of imaging studies in the medical record.
  • Improper coding of associated conditions such as infertility.

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

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

Common Clinical Scenarios

Evaluation of scrotal masses, management of male infertility, and post-operative follow-up.

Billing Considerations

Ensure clear documentation of the size and symptoms of the spermatocele, as well as any associated conditions.

Andrology

Documentation Requirements

Comprehensive assessment of male reproductive health, including fertility evaluations.

Common Clinical Scenarios

Assessment of sperm quality and motility, treatment of male infertility, and management of testicular disorders.

Billing Considerations

Document any impact of the spermatocele on fertility and any interventions performed.

Coding Guidelines

Inclusion Criteria

Use N43.40 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the condition, associated symptoms, and any diagnostic imaging performed
  • Include relevant history and physical examination findings to support the diagnosis

Exclusion Criteria

Do NOT use N43.40 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

55040CPT Code

Excision of spermatocele

Clinical Scenario

When a spermatocele causes discomfort or complications.

Documentation Requirements

Document the size of the spermatocele, symptoms, and rationale for surgery.

Specialty Considerations

Urologists should ensure that all pre-operative evaluations are documented.

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 treatment plans. This specificity helps in better tracking of male reproductive health issues and associated treatments.

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 treatment plans. This specificity helps in better tracking of male reproductive health issues and associated treatments.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like spermatocele, improving the accuracy of diagnoses and treatment plans. This specificity helps in better tracking of male reproductive health issues and associated treatments.

Resources

Clinical References

  • •
    American Urological Association Guidelines

Coding & Billing References

  • •
    American Urological Association Guidelines

Frequently Asked Questions

What is a spermatocele?

A spermatocele is a benign cystic structure that forms in the epididymis, typically containing fluid and sperm. It is usually asymptomatic and may not require treatment unless it causes discomfort.