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v1.0.0
ICD-10 Guide
ICD-10 CodesQ56.3

Q56.3

Billable

Pseudohermaphroditism, unspecified

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

Code Description

ICD-10 Q56.3 is a billable code used to indicate a diagnosis of pseudohermaphroditism, unspecified.

Key Diagnostic Point:

Pseudohermaphroditism is a condition characterized by ambiguous genitalia where an individual has external genitalia that do not match their chromosomal sex. This condition can arise from various genetic and hormonal factors affecting the development of the genital organs. In males, it may present with features such as hypospadias or cryptorchidism, while females may exhibit uterine malformations or other anomalies. The diagnosis of pseudohermaphroditism is often made through clinical examination, imaging studies, and genetic testing to determine the underlying cause. The management of this condition typically involves a multidisciplinary approach, including pediatric endocrinology, urology, and genetics, to address both the physical and psychological aspects of the disorder. Accurate coding is essential for proper treatment planning and insurance reimbursement, as well as for tracking epidemiological data related to congenital malformations.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation of ambiguous genitalia
  • Need for comprehensive genetic testing
  • Differential diagnosis with other intersex conditions
  • Documentation of associated anomalies (e.g., hypospadias, cryptorchidism)

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify associated congenital anomalies
  • Misclassification of the condition due to ambiguous terminology
  • Lack of genetic testing results in the medical record

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed physical examination findings, growth and development assessments, and any surgical interventions performed.

Common Clinical Scenarios

Evaluation of newborns with ambiguous genitalia, management of hypospadias repair, and follow-up for cryptorchidism.

Billing Considerations

Consideration of psychosocial impacts on the child and family, and the importance of a multidisciplinary team approach.

Genetics

Documentation Requirements

Genetic testing results, family history of congenital conditions, and any genetic counseling provided.

Common Clinical Scenarios

Assessment of chromosomal abnormalities, counseling for families with a history of intersex conditions, and interpretation of genetic test results.

Billing Considerations

Understanding the genetic basis of pseudohermaphroditism and its implications for future pregnancies.

Coding Guidelines

Inclusion Criteria

Use Q56.3 When
  • Follow the official ICD
  • CM guidelines for coding congenital malformations, ensuring specificity in documentation and coding based on clinical findings and diagnostic tests

Exclusion Criteria

Do NOT use Q56.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

54660CPT Code

Orchidopexy

Clinical Scenario

Used for surgical correction of cryptorchidism in patients with pseudohermaphroditism.

Documentation Requirements

Operative report detailing the procedure and indication.

Specialty Considerations

Pediatric urology should document the rationale for surgery.

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, 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, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American Academy of Pediatrics
  • •
    Genetics Home Reference

Coding & Billing References

  • •
    American Academy of Pediatrics
  • •
    Genetics Home Reference

Frequently Asked Questions

What is the difference between pseudohermaphroditism and true hermaphroditism?

Pseudohermaphroditism refers to individuals with ambiguous genitalia where the external genitalia do not match the chromosomal sex, while true hermaphroditism involves the presence of both ovarian and testicular tissue. Accurate coding requires understanding these distinctions.