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ICD-10 Guide
ICD-10 CodesN48.5

N48.5

Billable

Ulcer of penis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/18/2025

Code Description

ICD-10 N48.5 is a billable code used to indicate a diagnosis of ulcer of penis.

Key Diagnostic Point:

An ulcer of the penis is a localized area of tissue loss that can occur due to various underlying conditions, including infections, trauma, or inflammatory diseases. Clinically, these ulcers may present as painful lesions, which can be associated with other symptoms such as discharge, bleeding, or swelling. Common causes include sexually transmitted infections (STIs) like herpes simplex virus, syphilis, or chancroid, as well as non-infectious causes such as lichen planus or Behçet's disease. Diagnosis typically involves a thorough history and physical examination, often supplemented by laboratory tests to identify infectious agents. Treatment may include topical or systemic medications, depending on the underlying cause, and in some cases, surgical intervention may be necessary. Proper management is crucial to prevent complications such as secondary infections or scarring, which can impact sexual function and overall quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying causes requiring differential diagnosis.
  • Need for detailed clinical documentation to support the diagnosis.
  • Potential overlap with other penile disorders, complicating coding.
  • Variability in presentation and treatment options based on etiology.

Audit Risk Factors

  • Inadequate documentation of the ulcer's characteristics.
  • Failure to specify the underlying cause of the ulcer.
  • Misclassification of the ulcer type (e.g., infectious vs. non-infectious).
  • Lack of supporting lab results or imaging studies.

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed clinical notes including history, physical examination findings, and treatment plans.

Common Clinical Scenarios

Patients presenting with painful penile lesions, recurrent ulcers, or associated urinary symptoms.

Billing Considerations

Urologists must document the etiology of the ulcer and any associated conditions to ensure accurate coding.

Dermatology

Documentation Requirements

Comprehensive skin examination findings, including descriptions of the ulcer and any relevant skin conditions.

Common Clinical Scenarios

Patients with ulcers due to dermatological conditions like lichen planus or psoriasis.

Billing Considerations

Dermatologists should provide clear differentiation between infectious and non-infectious causes.

Coding Guidelines

Inclusion Criteria

Use N48.5 When
  • According to ICD
  • 10 guidelines, N48
  • 5 should be used when a patient presents with a documented ulcer of the penis
  • Coders must ensure that the underlying cause is clearly documented, as this may affect treatment and management

Exclusion Criteria

Do NOT use N48.5 When
  • Exclusion criteria include ulcers due to malignancy or trauma, which should be coded separately

Related ICD-10 Codes

Related CPT Codes

54050CPT Code

Incision and drainage of abscess, perineal area

Clinical Scenario

Used when an ulcer is complicated by an abscess.

Documentation Requirements

Document the need for drainage and the characteristics of the abscess.

Specialty Considerations

Urologists should ensure that the procedure is linked to the diagnosis of the ulcer.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of penile ulcers, improving the ability to capture the complexity of these conditions and their management. This specificity aids in better understanding patient populations and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of penile ulcers, improving the ability to capture the complexity of these conditions and their management. This specificity aids in better understanding patient populations and treatment outcomes.

Reimbursement & Billing Impact

reimbursement.

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 causes of penile ulcers?

Common causes include sexually transmitted infections, inflammatory conditions, and trauma. Accurate diagnosis is essential for appropriate treatment.