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ICD-10 Guide
ICD-10 CodesF52.5

F52.5

Billable

Vaginismus not due to a substance or known physiological condition

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

Code Description

ICD-10 F52.5 is a billable code used to indicate a diagnosis of vaginismus not due to a substance or known physiological condition.

Key Diagnostic Point:

Vaginismus is a condition characterized by involuntary contractions of the pelvic floor muscles, specifically the muscles surrounding the vagina, which can make penetration painful or impossible. This condition is not attributed to any substance use or identifiable physiological issues, such as infections or anatomical abnormalities. Vaginismus can be classified as a sexual dysfunction and is often associated with psychological factors, including anxiety, fear of pain, or past traumatic experiences. It can significantly impact a woman's sexual health and relationships, leading to distress and avoidance of sexual activity. Treatment typically involves a combination of physical therapy, counseling, and education about sexual health. Understanding the psychological and emotional aspects of vaginismus is crucial for effective management and resolution of the condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating vaginismus from other sexual dysfunctions
  • Understanding the psychological components involved
  • Need for comprehensive patient history and documentation
  • Potential overlap with other ICD-10 codes related to sexual dysfunction

Audit Risk Factors

  • Inadequate documentation of psychological assessments
  • Failure to document patient history related to trauma or anxiety
  • Misclassification of vaginismus with other sexual dysfunction codes
  • Lack of clear treatment plans in medical records

Specialty Focus

Medical Specialties

Gynecology

Documentation Requirements

Detailed patient history, including sexual history and psychological evaluations.

Common Clinical Scenarios

Patients presenting with pain during intercourse, difficulty with gynecological exams, or avoidance of sexual activity.

Billing Considerations

Consideration of the patient's emotional and psychological state is essential for accurate coding and treatment planning.

Psychiatry

Documentation Requirements

Comprehensive mental health assessments, including anxiety and trauma history.

Common Clinical Scenarios

Patients with a history of sexual trauma presenting with vaginismus symptoms.

Billing Considerations

Coordination with gynecological evaluations to ensure a holistic approach to treatment.

Coding Guidelines

Inclusion Criteria

Use F52.5 When
  • According to ICD
  • 10 coding guidelines, F52
  • 5 should be used when vaginismus is diagnosed without any known physiological or substance
  • related causes
  • Coders must ensure that thorough documentation supports the diagnosis and that other potential causes have been ruled out

Exclusion Criteria

Do NOT use F52.5 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97140CPT Code

Manual therapy techniques

Clinical Scenario

Used in conjunction with pelvic floor therapy for vaginismus.

Documentation Requirements

Document the specific techniques used and patient response.

Specialty Considerations

Physical therapists should coordinate with gynecologists for comprehensive care.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of sexual dysfunctions, including vaginismus, which aids in better understanding and treatment of the condition. It emphasizes the importance of psychological factors in sexual health.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of sexual dysfunctions, including vaginismus, which aids in better understanding and treatment of the condition. It emphasizes the importance of psychological factors in sexual health.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of sexual dysfunctions, including vaginismus, which aids in better understanding and treatment of the condition. It emphasizes the importance of psychological factors in sexual health.

Resources

Clinical References

  • •
    American Urological Association Guidelines

Coding & Billing References

  • •
    American Urological Association Guidelines

Frequently Asked Questions

What is vaginismus?

Vaginismus is a condition where involuntary muscle contractions prevent penetration, often linked to psychological factors.

How is vaginismus treated?

Treatment may include pelvic floor therapy, counseling, and education about sexual health.