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ICD-10 Guide
ICD-10 CodesQ55.8

Q55.8

Billable

Other specified congenital malformations of male genital organs

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

Code Description

ICD-10 Q55.8 is a billable code used to indicate a diagnosis of other specified congenital malformations of male genital organs.

Key Diagnostic Point:

Congenital malformations of male genital organs encompass a variety of conditions that can affect the development and function of the genitalia. This includes hypospadias, where the urethral opening is located on the underside of the penis rather than at the tip, and cryptorchidism, which is characterized by undescended testicles. Ambiguous genitalia, a condition where the external genitalia do not have a clear male or female appearance, can also fall under this category. Uterine malformations, while primarily affecting females, can be relevant in cases of intersex conditions or disorders of sexual development. These malformations can lead to complications such as urinary tract infections, fertility issues, and psychosocial challenges. Accurate coding is essential for appropriate management and treatment planning, as well as for research and epidemiological studies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of conditions
  • Need for precise documentation of anatomical anomalies
  • Differentiation between similar conditions (e.g., hypospadias vs. epispadias)
  • Potential for associated chromosomal abnormalities

Audit Risk Factors

  • Inadequate documentation of the specific malformation
  • Failure to capture associated conditions or syndromes
  • Misclassification of ambiguous genitalia
  • Lack of clarity on the treatment plan or surgical interventions

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed descriptions of physical examinations, growth patterns, and developmental milestones are crucial. Documentation should also include any surgical interventions or referrals to specialists.

Common Clinical Scenarios

Common scenarios include newborn assessments revealing hypospadias or cryptorchidism, and follow-up visits for surgical correction.

Billing Considerations

Pediatric coders must be aware of the age-specific implications of these conditions and the potential for long-term follow-up.

Genetics

Documentation Requirements

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

Common Clinical Scenarios

Scenarios may include genetic counseling for families with a history of congenital malformations or ambiguous genitalia.

Billing Considerations

Genetic coders should consider the implications of chromosomal abnormalities that may accompany these malformations.

Coding Guidelines

Inclusion Criteria

Use Q55.8 When
  • Coders should adhere to the official ICD
  • CM guidelines for congenital conditions, ensuring that all relevant clinical information is captured and that codes are assigned based on the most specific diagnosis available

Exclusion Criteria

Do NOT use Q55.8 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

54160CPT Code

Repair of hypospadias

Clinical Scenario

Used when a patient with hypospadias undergoes surgical correction.

Documentation Requirements

Operative reports detailing the procedure and any complications.

Specialty Considerations

Pediatric urologists typically perform these procedures.

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 data accuracy and facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving data accuracy and facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving data accuracy and facilitating better patient management.

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 documentation is required for coding Q55.8?

Documentation should include a detailed description of the malformation, any associated conditions, and the treatment plan. Surgical reports and genetic evaluations are also important.