ICD-10 Coding for Endometriosis(N80.0, N80.1)
Complete ICD-10-CM coding and documentation guide for Endometriosis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Endometriosis
N80.0-N80.9Primary Range
Endometriosis of pelvic and other specified sites
This range covers the primary codes for endometriosis, specifying the anatomical site and depth.
Endometriosis of extrapelvic sites
This range includes codes for endometriosis affecting extrapelvic locations such as the bladder and ureter.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N80.0 | Endometriosis of uterus | Use when endometriosis is confirmed in the uterine tissue. |
|
| N80.1 | Endometriosis of ovary | Use when endometriosis is confirmed in the ovarian tissue. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for endometriosis
Essential facts and insights about Endometriosis
Primary ICD-10-CM Codes for endometriosis
Decision Criteria
clinical Criteria
- Presence of endometrial tissue in the uterus confirmed by laparoscopy
Applicable To
- Adenomyosis
Excludes
- Uterine fibroids (D26.0)
Clinical Validation Requirements
- Laparoscopic confirmation of endometrial tissue in the uterus
Code-Specific Risks
- Risk of misclassification with uterine fibroids
Coding Notes
- Ensure documentation specifies the uterine involvement to avoid confusion with fibroids.
N80.1 - Endometriosis of ovary
Use when endometriosis is confirmed in the ovarian tissue.
Applicable To
- Ovarian endometrioma
Excludes
- Ovarian cyst (N83.2)
Clinical Validation Requirements
- Imaging showing T1 hyperintense ovarian cysts with T2 shading
Coding Notes
Document the laterality and depth of ovarian involvement.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Endometriosis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N80.0.
Impact
Clinical: Impacts treatment planning and follow-up., Regulatory: Non-compliance with coding guidelines., Financial: Potential for denied claims.
Mitigation Strategy
Use templates that prompt for laterality, Educate clinicians on documentation standards
Impact
Reimbursement: May lead to lower DRG assignment and reimbursement., Compliance: Increases risk of audit due to lack of specificity., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Query provider for specific site and depth details.
Impact
High audit risk when using N80.9 without justification.
Mitigation Strategy
Ensure documentation supports the most specific code.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Endometriosis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Endometriosis
Use these documentation templates to ensure complete and accurate documentation for Endometriosis. These templates include all required elements for proper coding and billing.
Laparoscopic excision of endometriosis
Specialty: GynecologyRequired Elements
- Preoperative diagnosis
- Operative findings
- Procedures performed
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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