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v1.0.0
ICD-10 Guide
ICD-10 CodesQ55.1

Q55.1

Billable

Hypoplasia of testis and scrotum

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 Q55.1 is a billable code used to indicate a diagnosis of hypoplasia of testis and scrotum.

Key Diagnostic Point:

Hypoplasia of the testis and scrotum is a congenital condition characterized by underdevelopment of the testicular tissue and the scrotum. This condition can lead to various complications, including infertility, hormonal imbalances, and increased risk of testicular cancer. It may present as a unilateral or bilateral condition, with the severity of hypoplasia varying significantly among affected individuals. In some cases, hypoplasia may be associated with other congenital anomalies, such as cryptorchidism (undescended testis) or hypospadias (abnormal urethral opening). The diagnosis is typically made through physical examination and imaging studies, such as ultrasound, which can assess the size and structure of the testes. Management may involve hormonal therapy, surgical intervention, or close monitoring, depending on the severity of the condition and associated anomalies. Early diagnosis and intervention are crucial for optimizing outcomes and addressing any potential complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of hypoplasia
  • Potential association with other congenital anomalies
  • Need for comprehensive documentation of associated conditions
  • Differentiation from similar conditions like cryptorchidism

Audit Risk Factors

  • Inadequate documentation of associated congenital anomalies
  • Failure to specify laterality (unilateral vs. bilateral)
  • Misclassification with other genital malformations
  • Lack of supporting clinical evidence for the diagnosis

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed pediatric history, physical examination findings, and any imaging studies performed.

Common Clinical Scenarios

Evaluation of a newborn with ambiguous genitalia, assessment of a child with cryptorchidism, or follow-up of a child with a known history of testicular hypoplasia.

Billing Considerations

Consideration of growth and development milestones, as well as psychosocial implications for the child and family.

Genetics

Documentation Requirements

Genetic testing results, family history of congenital conditions, and any syndromic associations.

Common Clinical Scenarios

Genetic counseling for families with a history of testicular malformations or syndromes associated with hypoplasia.

Billing Considerations

Awareness of chromosomal abnormalities that may be associated with hypoplasia, such as Klinefelter syndrome.

Coding Guidelines

Inclusion Criteria

Use Q55.1 When
  • Follow the official ICD
  • CM coding guidelines for congenital malformations, ensuring accurate documentation of the condition and any associated anomalies
  • Use additional codes as necessary to capture the full clinical picture

Exclusion Criteria

Do NOT use Q55.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

54660CPT Code

Orchidopexy

Clinical Scenario

Used for surgical correction of undescended testis associated with hypoplasia.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Pediatric urology may require specific documentation standards.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 allows for more specific coding of congenital conditions, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 allows for more specific coding of congenital conditions, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 hypoplasia and agenesis of the testis?

Hypoplasia refers to underdevelopment of the testis, where some testicular tissue is present, while agenesis indicates complete absence of the testis. Accurate coding requires careful documentation of the clinical findings.