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ICD-10 Guide
ICD-10 CodesN85.9

N85.9

Billable

Noninflammatory disorder of uterus, unspecified

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

Code Description

ICD-10 N85.9 is a billable code used to indicate a diagnosis of noninflammatory disorder of uterus, unspecified.

Key Diagnostic Point:

N85.9 refers to a noninflammatory disorder of the uterus that is unspecified. This category encompasses a variety of uterine conditions that do not involve inflammation, such as uterine fibroids, adenomyosis, and other structural abnormalities. These disorders can lead to symptoms such as abnormal uterine bleeding, pelvic pain, and reproductive issues. The diagnosis is often made through imaging studies like ultrasound or MRI, and may require further evaluation to rule out malignancy or other significant pathology. Accurate coding is essential for appropriate management and treatment planning, as well as for ensuring proper reimbursement. Given the broad nature of this code, it is crucial for coders to have a comprehensive understanding of the clinical context and the specific details of the patient's condition to ensure accurate coding and avoid potential audit issues.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying conditions that fall under this code
  • Need for detailed clinical documentation to support the diagnosis
  • Differentiation from inflammatory conditions which may require different coding
  • Potential overlap with other gynecological disorders

Audit Risk Factors

  • Insufficient documentation to support the unspecified nature of the disorder
  • Misinterpretation of symptoms leading to incorrect coding
  • Failure to document the clinical rationale for using an unspecified code
  • Inadequate follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed patient history, physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with abnormal uterine bleeding, pelvic pain, or infertility evaluations.

Billing Considerations

Ensure that all relevant diagnostic tests and their results are documented to support the diagnosis.

Radiology

Documentation Requirements

Imaging reports that clearly indicate findings related to noninflammatory uterine disorders.

Common Clinical Scenarios

Ultrasound or MRI findings suggestive of fibroids or other structural abnormalities.

Billing Considerations

Radiologists should provide clear descriptions of findings to assist in accurate coding.

Coding Guidelines

Inclusion Criteria

Use N85.9 When
  • According to ICD
  • 10 coding guidelines, N85
  • 9 should be used when the specific type of noninflammatory disorder of the uterus is not documented
  • Coders should ensure that the diagnosis is supported by clinical documentation and that other more specific codes are not applicable

Exclusion Criteria

Do NOT use N85.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

58150CPT Code

Total abdominal hysterectomy

Clinical Scenario

Used when a patient with a noninflammatory disorder requires surgical intervention.

Documentation Requirements

Operative report detailing the indication for surgery and findings.

Specialty Considerations

Obstetricians should ensure that the diagnosis aligns with the surgical procedure performed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specificity in coding, but it has also introduced complexity with codes like N85.9. Coders must be diligent in ensuring that documentation supports the use of unspecified codes to avoid denials and audits.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding, but it has also introduced complexity with codes like N85.9. Coders must be diligent in ensuring that documentation supports the use of unspecified codes to avoid denials and audits.

Reimbursement & Billing Impact

reimbursement and to justify the medical necessity of services rendered.

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

When should I use N85.9?

N85.9 should be used when there is a noninflammatory disorder of the uterus that is not specified in the medical record. Ensure that the documentation supports the use of this code and that no more specific diagnosis is available.