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ICD-10 Guide
ICD-10 CodesQ55.4

Q55.4

Billable

Other congenital malformations of vas deferens, epididymis, seminal vesicles and prostate

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

Code Description

ICD-10 Q55.4 is a billable code used to indicate a diagnosis of other congenital malformations of vas deferens, epididymis, seminal vesicles and prostate.

Key Diagnostic Point:

Congenital malformations of the male reproductive system can significantly impact fertility and overall health. This code encompasses a variety of conditions affecting the vas deferens, epididymis, seminal vesicles, and prostate. Common congenital anomalies include agenesis or hypoplasia of these structures, which may lead to obstructive azoospermia or infertility. Other conditions may involve abnormal positioning or structural deformities that can complicate normal reproductive function. In pediatric patients, these malformations may present with symptoms such as urinary tract infections, abnormal genitalia, or issues with sexual development. Early diagnosis and intervention are crucial for managing these conditions, which may require a multidisciplinary approach involving urologists, endocrinologists, and geneticists to address both the physical and psychological aspects of care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of malformations
  • Need for detailed anatomical descriptions in documentation
  • Potential overlap with other congenital conditions
  • Requirement for genetic evaluation in some cases

Audit Risk Factors

  • Inadequate documentation of the specific malformation
  • Failure to include associated conditions or syndromes
  • Misclassification of congenital versus acquired conditions
  • Lack of genetic testing results when relevant

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed clinical notes describing the child's growth, development, and any associated symptoms or conditions.

Common Clinical Scenarios

Cases of cryptorchidism, hypospadias, or ambiguous genitalia requiring surgical intervention or hormonal therapy.

Billing Considerations

Pediatric coders must be aware of the developmental implications of these conditions and the importance of early intervention.

Genetics

Documentation Requirements

Genetic testing results, family history, and any syndromic associations must be documented to support the diagnosis.

Common Clinical Scenarios

Genetic counseling for families with a history of congenital malformations or chromosomal abnormalities.

Billing Considerations

Genetic coders should ensure that all relevant genetic syndromes are considered when coding.

Coding Guidelines

Inclusion Criteria

Use Q55.4 When
  • Follow the official ICD
  • CM coding guidelines for congenital conditions, ensuring that all relevant clinical information is documented and that codes accurately reflect the patient's condition

Exclusion Criteria

Do NOT use Q55.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

54660CPT Code

Orchidopexy

Clinical Scenario

Used for surgical correction of cryptorchidism in pediatric patients.

Documentation Requirements

Surgical notes detailing the procedure and pre-operative assessments.

Specialty Considerations

Urologists must document the specifics of the malformation and any associated conditions.

54300CPT Code

Hypospadias repair

Clinical Scenario

Surgical intervention for hypospadias in children.

Documentation Requirements

Detailed operative reports and post-operative follow-up notes.

Specialty Considerations

Pediatric surgeons should ensure accurate coding of the procedure and associated congenital conditions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the accuracy of data collection and reimbursement processes. This specificity aids in better understanding the prevalence and management of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the accuracy of data collection and reimbursement processes. This specificity aids in better understanding the prevalence and management of these conditions.

Reimbursement & Billing Impact

reimbursement processes. This specificity aids in better understanding the prevalence and management of these conditions.

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 are the common congenital malformations associated with Q55.4?

Common congenital malformations associated with Q55.4 include agenesis or hypoplasia of the vas deferens, epididymis, seminal vesicles, and prostate, which can lead to fertility issues and other complications.