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ICD-10 Guide
ICD-10 CodesN43.42

N43.42

Billable

Spermatocele of epididymis, multiple

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

Code Description

ICD-10 N43.42 is a billable code used to indicate a diagnosis of spermatocele of epididymis, multiple.

Key Diagnostic Point:

Spermatocele is a benign cystic formation that occurs in the epididymis, typically filled with a milky or clear fluid containing spermatozoa. When multiple spermatoceles are present, they can cause discomfort, swelling, or a feeling of heaviness in the scrotum. These cysts are often asymptomatic and may be discovered incidentally during a physical examination or imaging studies. The exact etiology of spermatoceles is not fully understood, but they are thought to arise from obstruction of the epididymal ducts. While spermatoceles are generally harmless, they can sometimes be confused with other testicular disorders such as hydrocele, orchitis, or tumors. In cases where multiple spermatoceles are present, careful evaluation is necessary to rule out malignancy and to assess for potential impacts on male fertility. Management may include observation, pain management, or surgical intervention if symptoms are significant or if there is concern for complications. Understanding the relationship between spermatoceles and other male reproductive health issues is crucial for effective diagnosis and treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other testicular disorders such as hydrocele and orchitis.
  • Need for accurate documentation of multiple lesions.
  • Potential for co-existing conditions affecting coding.
  • Variability in clinical presentation and symptoms.

Audit Risk Factors

  • Inadequate documentation of the number of spermatoceles.
  • Failure to differentiate from other similar conditions.
  • Lack of imaging reports to support diagnosis.
  • Misuse of codes for related conditions.

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed descriptions of the size, number, and symptoms associated with the spermatoceles, as well as any imaging studies performed.

Common Clinical Scenarios

Patients presenting with scrotal swelling, discomfort, or incidental findings on imaging.

Billing Considerations

Urologists must ensure that all relevant findings are documented to support the diagnosis and any potential surgical interventions.

Andrology

Documentation Requirements

Assessment of male fertility status and any associated reproductive health issues.

Common Clinical Scenarios

Evaluation of male infertility where spermatoceles may impact sperm quality.

Billing Considerations

Andrologists should document the impact of spermatoceles on fertility and any treatments provided.

Coding Guidelines

Inclusion Criteria

Use N43.42 When
  • According to ICD
  • 10 guidelines, N43
  • 42 should be used when multiple spermatoceles are confirmed through clinical examination or imaging
  • Documentation must clearly indicate the presence of multiple lesions and any associated symptoms

Exclusion Criteria

Do NOT use N43.42 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

55040CPT Code

Epididymal cyst aspiration

Clinical Scenario

Used when a spermatocele is symptomatic and requires intervention.

Documentation Requirements

Document the size of the cyst and symptoms prompting aspiration.

Specialty Considerations

Urologists should ensure that the procedure is justified based on clinical findings.

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 tracking. This specificity aids in better patient management and resource allocation.

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 tracking. This specificity aids in better patient management and resource allocation.

Reimbursement & Billing Impact

reimbursement and to avoid denials.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between a spermatocele and a hydrocele?

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