ICD-10 Coding for Pelvic Congestion Syndrome(N94.89, I87.2)
Complete ICD-10-CM coding and documentation guide for Pelvic Congestion Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pelvic Congestion Syndrome
N94-N99Primary Range
Noninflammatory disorders of female genital tract
This range includes codes for pelvic congestion syndrome and related conditions affecting the female genital tract.
Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified
This range includes codes for venous insufficiency, which is often an underlying cause of pelvic congestion syndrome.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N94.89 | Other specified conditions associated with female genital organs and menstrual cycle | Use when pelvic congestion syndrome is diagnosed without a specific underlying venous insufficiency. |
|
| I87.2 | Venous insufficiency (chronic) (peripheral) | Use when venous insufficiency is confirmed and treated, especially if intervention is performed. |
|
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 pelvic congestion syndrome
Essential facts and insights about Pelvic Congestion Syndrome
Primary ICD-10-CM Codes for pelvic congestion syndrome
Decision Criteria
clinical Criteria
- Presence of chronic pelvic pain >6 months
documentation Criteria
- Venogram or imaging confirming ovarian vein reflux
Clinical Validation Requirements
- Chronic pelvic pain >6 months
- Pain worsens with standing or menses
- Venogram shows ovarian vein diameter >6mm with reflux
Code-Specific Risks
- Risk of denial if underlying cause is not documented
- Potential for incorrect DRG assignment if used as principal without justification
Coding Notes
- Ensure documentation includes specific symptoms and imaging findings to support PCS diagnosis.
I87.2 - Venous insufficiency (chronic) (peripheral)
Use when venous insufficiency is confirmed and treated, especially if intervention is performed.
Applicable To
- Chronic venous insufficiency
Excludes
- Varicose veins of lower extremities (I83.-)
Clinical Validation Requirements
- Venogram shows venous reflux
- Ovarian vein diameter >6mm
Coding Notes
Ensure documentation specifies the venous insufficiency as the focus of treatment if used as principal.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pelvic and perineal pain
R10.2Differential 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 Pelvic Congestion Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N94.89.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Increased risk of audit and denial., Financial: Potential loss of reimbursement for procedures.
Mitigation Strategy
Ensure imaging reports are included in the medical record, Verify documentation before coding
Impact
Reimbursement: May result in lower DRG payment if not coded correctly., Compliance: Risk of audit failure if documentation does not support coding., Data Quality: Inaccurate data representation of patient's condition.
Mitigation Strategy
Link venous incompetence to intervention and use both codes.
Impact
Claims may be denied if imaging findings are not documented.
Mitigation Strategy
Ensure all imaging reports are included in the patient's record.
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 Pelvic Congestion Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pelvic Congestion Syndrome
Use these documentation templates to ensure complete and accurate documentation for Pelvic Congestion Syndrome. These templates include all required elements for proper coding and billing.
Interventional Radiology Procedure Note
Specialty: Interventional RadiologyRequired Elements
- Indication for procedure
- Imaging findings
- Procedure details
- Post-operative diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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