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v1.0.0
ICD-10 Guide
ICD-10 CodesQ55.69

Q55.69

Billable

Other congenital malformation of penis

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

Code Description

ICD-10 Q55.69 is a billable code used to indicate a diagnosis of other congenital malformation of penis.

Key Diagnostic Point:

Congenital malformations of the penis encompass a variety of conditions that can affect the structure and function of the male genitalia. This includes conditions such as hypospadias, where the urethral opening is located on the underside of the penis rather than at the tip, and can vary in severity. Cryptorchidism, or undescended testicles, is another common condition that may accompany penile malformations. Ambiguous genitalia, where the external genitalia do not clearly indicate male or female, can also be associated with chromosomal abnormalities such as Turner syndrome or androgen insensitivity syndrome. Uterine malformations, while primarily affecting females, can also have implications for male genital development in cases of intersex variations. Accurate diagnosis and coding of these conditions are crucial for appropriate management and treatment, as they can have significant implications for reproductive health and psychosocial development.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of conditions
  • Need for precise anatomical terminology
  • Potential for associated conditions (e.g., cryptorchidism)
  • Documentation of genetic factors or syndromic associations

Audit Risk Factors

  • Inadequate documentation of the specific malformation
  • Failure to document associated conditions or syndromes
  • Misclassification of congenital versus acquired conditions
  • Lack of clarity in the anatomical description

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed descriptions of the malformation, associated conditions, and any surgical interventions performed.

Common Clinical Scenarios

Cases of hypospadias repair, cryptorchidism management, and evaluation of ambiguous genitalia in newborns.

Billing Considerations

Consideration of the psychosocial impact of genital malformations on the child and family.

Genetics

Documentation Requirements

Genetic testing results, family history of congenital conditions, and any syndromic associations.

Common Clinical Scenarios

Genetic counseling for families with a history of congenital malformations and evaluation of chromosomal abnormalities.

Billing Considerations

Understanding the implications of genetic syndromes that may present with genital malformations.

Coding Guidelines

Inclusion Criteria

Use Q55.69 When
  • Follow the ICD
  • CM guidelines for coding congenital malformations, ensuring specificity in the documentation of the malformation type and any associated conditions

Exclusion Criteria

Do NOT use Q55.69 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

54300CPT Code

Hypospadias repair

Clinical Scenario

Used during surgical correction of hypospadias.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Pediatric urology may have specific coding nuances.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding congenital malformations, 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 congenital malformations of the penis?

Common congenital malformations include hypospadias, epispadias, and ambiguous genitalia. Each condition has specific coding requirements and implications for treatment.