ICD-10 Coding for Gynecomastia(N62)
Complete ICD-10-CM coding and documentation guide for Gynecomastia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gynecomastia
Key Information: ICD-10 code for gynecomastia
Essential facts and insights about Gynecomastia
Primary ICD-10-CM Code for gynecomastia
Decision Criteria
clinical Criteria
- Presence of glandular tissue confirmed by physical exam and imaging.
documentation Criteria
- Detailed history of symptoms, duration, and treatment attempts.
Applicable To
- True glandular hypertrophy in males
Clinical Validation Requirements
- Palpable firm/glandular tissue >2cm diameter
- Duration >12 months in adolescents/6 months in adults
- Negative β-hCG, testosterone <300 ng/dL, estradiol >40 pg/mL
Code-Specific Risks
- Confusion with pseudogynecomastia
- Incorrect sequencing with underlying causes
Coding Notes
- Ensure clinical documentation supports the diagnosis with lab and imaging evidence.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gynecomastia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N62.
Impact
Clinical: May lead to misdiagnosis if not clinically correlated., Regulatory: Non-compliance with clinical diagnosis standards., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Ensure clinical evaluation corroborates pathology findings., Document clinical findings thoroughly.
Impact
Reimbursement: Incorrect sequencing can lead to claim denials., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Always code the underlying cause first, followed by N62.
Impact
Inadequate documentation can lead to audit failures.
Mitigation Strategy
Ensure all criteria for surgical intervention are documented.
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 Gynecomastia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gynecomastia
Use these documentation templates to ensure complete and accurate documentation for Gynecomastia. These templates include all required elements for proper coding and billing.
Endocrinology consultation for persistent gynecomastia
Specialty: EndocrinologyRequired Elements
- Reason for consultation
- History of present illness
- Physical exam findings
- Laboratory results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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