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v1.0.0
ICD-10 Guide
ICD-10 CodesN81.9

N81.9

Billable

Female genital prolapse, unspecified

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

Code Description

ICD-10 N81.9 is a billable code used to indicate a diagnosis of female genital prolapse, unspecified.

Key Diagnostic Point:

Female genital prolapse is a condition where pelvic organs, such as the uterus, bladder, or rectum, descend into or protrude out of the vaginal canal due to weakened pelvic support structures. This condition can result from various factors, including childbirth, aging, hormonal changes, and connective tissue disorders. Symptoms may include a sensation of heaviness or pressure in the pelvic area, urinary incontinence, difficulty with bowel movements, and discomfort during sexual intercourse. The unspecified designation indicates that the specific type of prolapse (e.g., uterine, vaginal, or rectocele) has not been determined. It is essential to conduct a thorough clinical evaluation to identify any associated conditions, such as endometriosis, which can complicate the presentation of prolapse, or the presence of fistulas, ovarian disorders, or polyps in the female genital tract. Accurate diagnosis and management are crucial for improving the quality of life for affected individuals.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptoms and presentations of prolapse
  • Need for comprehensive pelvic examination to determine type of prolapse
  • Potential overlap with other gynecological conditions (e.g., endometriosis, fistulas)
  • Documentation of associated conditions that may affect treatment

Audit Risk Factors

  • Inadequate documentation of symptoms and clinical findings
  • Failure to specify the type of prolapse when known
  • Lack of supporting documentation for associated conditions
  • Inconsistent coding practices among providers

Specialty Focus

Medical Specialties

Gynecology

Documentation Requirements

Detailed pelvic examination findings, patient history, and symptom description.

Common Clinical Scenarios

Patients presenting with pelvic pressure, urinary incontinence, or vaginal bulging.

Billing Considerations

Consideration of surgical history and childbirth history is crucial for accurate coding.

Urology

Documentation Requirements

Assessment of urinary symptoms and any associated urological conditions.

Common Clinical Scenarios

Patients with urinary incontinence related to pelvic organ prolapse.

Billing Considerations

Coordination with gynecological assessments for comprehensive care.

Coding Guidelines

Inclusion Criteria

Use N81.9 When
  • Follow official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include any relevant associated conditions and specify the type of prolapse when possible

Exclusion Criteria

Do NOT use N81.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

57260CPT Code

Vaginal repair of cystocele

Clinical Scenario

Used when surgical intervention for cystocele is performed.

Documentation Requirements

Document the type of prolapse and surgical details.

Specialty Considerations

Gynecological specialties should ensure accurate coding based on surgical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of female genital prolapse, enabling better tracking of treatment outcomes and healthcare resource utilization. N81.9 serves as a catch-all for unspecified cases, but coders are encouraged to specify when possible.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of female genital prolapse, enabling better tracking of treatment outcomes and healthcare resource utilization. N81.9 serves as a catch-all for unspecified cases, but coders are encouraged to specify when possible.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of female genital prolapse, enabling better tracking of treatment outcomes and healthcare resource utilization. N81.9 serves as a catch-all for unspecified cases, but coders are encouraged to specify when possible.

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 should I document to support the use of N81.9?

Document the patient's symptoms, the results of the pelvic examination, and any associated conditions that may impact treatment. Ensure that the type of prolapse is specified if known.