ICD-10 Coding for Polycystic Ovary Syndrome(E28.2)
Complete ICD-10-CM coding and documentation guide for Polycystic Ovary Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Polycystic Ovary Syndrome
E28-E28.9Primary Range
Ovarian dysfunction
This range includes codes for ovarian dysfunction, with E28.2 specifically for PCOS.
Excessive, frequent and irregular menstruation
This range includes codes for menstrual irregularities, which are common symptoms of PCOS.
Key Information: ICD-10 code for PCOS
Essential facts and insights about Polycystic Ovary Syndrome
Primary ICD-10-CM Code for pcos
Decision Criteria
clinical Criteria
- Presence of two out of three Rotterdam criteria
documentation Criteria
- Detailed ultrasound and lab results
Applicable To
- Polycystic ovaries
Excludes
- Ovarian hyperstimulation syndrome (E28.3)
Clinical Validation Requirements
- Rotterdam criteria: oligo-anovulation, hyperandrogenism, polycystic ovaries
- Ultrasound showing ≥20 follicles per ovary
- Elevated free testosterone >6.4 pg/mL
Code-Specific Risks
- Incorrectly coding for diabetes when metformin is used for PCOS-related insulin resistance.
Coding Notes
- Ensure documentation supports the use of E28.2 by confirming diagnostic criteria.
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 Polycystic Ovary Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E28.2.
Impact
Clinical: Potential misdiagnosis of PCOS., Regulatory: Non-compliance with coding standards., Financial: Incorrect billing and potential claim denials.
Mitigation Strategy
Ensure documentation includes specific criteria and test results.
Impact
Reimbursement: Incorrect reimbursement for diabetes management., Compliance: Non-compliance with coding guidelines., Data Quality: Misrepresentation of patient condition in records.
Mitigation Strategy
Confirm the indication for metformin use and code accordingly.
Impact
Coding related conditions like diabetes instead of PCOS-related insulin resistance.
Mitigation Strategy
Verify the primary condition being treated and code accordingly.
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 Polycystic Ovary Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Polycystic Ovary Syndrome
Use these documentation templates to ensure complete and accurate documentation for Polycystic Ovary Syndrome. These templates include all required elements for proper coding and billing.
Endocrinology Progress Note
Specialty: EndocrinologyRequired Elements
- Patient history meeting Rotterdam criteria
- Ultrasound findings
- Laboratory results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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