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ICD-10 Guide
ICD-10 CodesE34.5

E34.5

Billable

Androgen insensitivity syndrome

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 E34.5 is a billable code used to indicate a diagnosis of androgen insensitivity syndrome.

Key Diagnostic Point:

Androgen insensitivity syndrome (AIS) is a genetic condition that affects sexual development before birth and during puberty. Individuals with AIS are genetically male (XY chromosomes) but have a mutation in the androgen receptor gene, leading to an inability to respond to male hormones (androgens). As a result, they may develop female physical traits despite having male chromosomes. During puberty, individuals with complete AIS typically do not develop secondary male sexual characteristics, such as facial hair or a deep voice, and may present with a female phenotype, including breast development. The condition can lead to various complications, including infertility and an increased risk of certain cancers, such as gonadal tumors. Diagnosis is often made through clinical evaluation, genetic testing, and imaging studies to assess internal reproductive structures. Management may involve hormone replacement therapy and surgical interventions, depending on the individual's needs and desires.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Genetic testing and interpretation of results
  • Variability in clinical presentation (complete vs. partial AIS)
  • Need for multidisciplinary approach in management
  • Potential for associated conditions (e.g., gonadal tumors)

Audit Risk Factors

  • Inadequate documentation of genetic testing results
  • Failure to document the patient's gender identity and preferences
  • Misclassification of AIS type (complete vs. partial)
  • Lack of follow-up documentation for associated conditions

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Thorough documentation of hormonal evaluations and treatment plans.

Common Clinical Scenarios

Management of hormone replacement therapy and monitoring for complications.

Billing Considerations

Endocrinologists must document the rationale for treatment choices and any genetic counseling provided.

Genetics

Documentation Requirements

Detailed family history and genetic testing results.

Common Clinical Scenarios

Counseling patients and families about inheritance patterns and implications.

Billing Considerations

Geneticists should document the specific mutations identified and their clinical significance.

Coding Guidelines

Inclusion Criteria

Use E34.5 When
  • According to ICD
  • 10 guidelines, E34
  • 5 should be used when there is a confirmed diagnosis of androgen insensitivity syndrome
  • It is important to document the type of AIS (complete or partial) and any associated conditions

Exclusion Criteria

Do NOT use E34.5 When
  • Exclusion criteria include other disorders of sexual development that do not involve androgen receptor mutations

Related ICD-10 Codes

Related CPT Codes

88305CPT Code

Pathology consultation for genetic testing

Clinical Scenario

Used when genetic testing is performed to confirm AIS.

Documentation Requirements

Documentation of the reason for testing and results.

Specialty Considerations

Geneticists must ensure that the testing aligns with 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 androgen insensitivity syndrome, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of androgen insensitivity syndrome, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    Androgen Insensitivity Syndrome Support Group

Coding & Billing References

  • •
    Androgen Insensitivity Syndrome Support Group

Frequently Asked Questions

What is the primary cause of androgen insensitivity syndrome?

AIS is primarily caused by mutations in the androgen receptor gene, which impairs the body's ability to respond to androgens, leading to a range of phenotypic presentations.