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v1.0.0
ICD-10 Guide
ICD-10 CodesQ52.3

Q52.3

Billable

Imperforate hymen

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 Q52.3 is a billable code used to indicate a diagnosis of imperforate hymen.

Key Diagnostic Point:

Imperforate hymen is a congenital malformation characterized by the absence of an opening in the hymen, which can obstruct menstrual flow and lead to complications such as hematocolpos. This condition is typically diagnosed in adolescence when menstruation begins, but it can also be identified earlier if there are signs of urinary obstruction or abdominal pain. The hymen is a thin membrane that partially covers the vaginal opening, and its absence or malformation can lead to various clinical issues. Treatment usually involves surgical intervention to create an appropriate opening, allowing for normal menstrual flow and reducing the risk of infection or other complications. It is essential for healthcare providers to assess for associated anomalies, particularly in the context of other congenital malformations of the genital organs, such as hypospadias, cryptorchidism, and uterine malformations, which may co-occur in patients with similar developmental issues.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and symptoms among patients
  • Need for comprehensive documentation of associated anomalies
  • Potential for misdiagnosis with other genital malformations
  • Surgical intervention requirements and coding for procedures

Audit Risk Factors

  • Inadequate documentation of symptoms leading to diagnosis
  • Failure to document associated congenital anomalies
  • Incorrect coding of surgical procedures related to treatment
  • Misalignment between diagnosis and procedure codes

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed history of symptoms, physical examination findings, and any imaging studies performed.

Common Clinical Scenarios

A pediatric patient presenting with abdominal pain and difficulty menstruating, leading to the diagnosis of imperforate hymen.

Billing Considerations

Consideration of the patient's age and developmental stage is crucial for accurate coding and management.

Genetics

Documentation Requirements

Family history of congenital anomalies, genetic counseling notes, and any chromosomal studies performed.

Common Clinical Scenarios

A patient with imperforate hymen presenting with other congenital anomalies, requiring genetic evaluation.

Billing Considerations

Understanding the potential genetic syndromes associated with genital malformations is essential for accurate coding.

Coding Guidelines

Inclusion Criteria

Use Q52.3 When
  • Follow the official ICD
  • CM guidelines for coding congenital malformations, ensuring accurate documentation of the condition and any associated anomalies
  • Use additional codes as necessary to capture the full clinical picture

Exclusion Criteria

Do NOT use Q52.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

58120CPT Code

Hymenectomy

Clinical Scenario

Performed to correct imperforate hymen.

Documentation Requirements

Operative report detailing the procedure and indication.

Specialty Considerations

Pediatric surgical notes should include details on the patient's age and any associated conditions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital conditions, including imperforate hymen, 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 congenital conditions, including imperforate hymen, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 symptoms of imperforate hymen?

Common symptoms include abdominal pain, difficulty menstruating, and urinary obstruction. Diagnosis is typically made during adolescence when menstruation begins.