ICD-10 Coding for Pelvic Prolapse(N81.3, N81.11, N81.6)
Complete ICD-10-CM coding and documentation guide for Pelvic Prolapse. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pelvic Prolapse
N81.0-N81.9Primary Range
Female genital prolapse
This range includes all types of pelvic organ prolapse, including uterine, vaginal, cystocele, and rectocele.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N81.3 | Complete uterovaginal prolapse | Use when documentation confirms complete uterovaginal prolapse. |
|
| N81.11 | Midline cystocele | Use for isolated cystocele without uterovaginal prolapse. |
|
| N81.6 | Rectocele | Use for isolated rectocele without uterovaginal prolapse. |
|
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 complete uterovaginal prolapse
Essential facts and insights about Pelvic Prolapse
Primary ICD-10-CM Codes for pelvic prolapse
Decision Criteria
clinical Criteria
- Complete eversion of uterus and vagina
Applicable To
- Rectocele
- Cystocele
Excludes
- N39.3 (Stress incontinence without prolapse)
N81.11 - Midline cystocele
Use for isolated cystocele without uterovaginal prolapse.
Excludes
- N81.3 (Complete uterovaginal prolapse)
Clinical Validation Requirements
- Midline anterior vaginal wall bulge on Valsalva
Coding Notes
Ensure documentation specifies isolated cystocele.
N81.6 - Rectocele
Use for isolated rectocele without uterovaginal prolapse.
Excludes
- N81.3 (Complete uterovaginal prolapse)
Clinical Validation Requirements
- Posterior vaginal wall protrusion with splinting needed
Coding Notes
Ensure documentation specifies isolated rectocele.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Prolapse due to obstetric trauma
N99.3Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Pelvic Prolapse to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N81.3.
Impact
Clinical: Leads to inadequate treatment planning., Regulatory: Fails to meet coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Use specific anatomical terms., Include POP-Q measurements.
Impact
Reimbursement: May lead to incorrect DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use N81.3 alone if complete prolapse is documented.
Impact
Using N81.3 with specific prolapse codes without proper documentation.
Mitigation Strategy
Ensure complete documentation supports code selection.
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 Prolapse, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pelvic Prolapse
Use these documentation templates to ensure complete and accurate documentation for Pelvic Prolapse. These templates include all required elements for proper coding and billing.
Documenting Pelvic Organ Prolapse
Specialty: GynecologyRequired Elements
- POP-Q measurements
- Prolapse type and stage
- Symptoms and clinical findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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