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E28.2
ICD-10-CM
Polycystic Ovary Syndrome

Find comprehensive information on Polycystic Ovary Syndrome (PCOS) diagnosis, including clinical documentation, medical coding, ICD-10 codes (E28.2), and SNOMED CT concepts. Learn about PCOS symptoms, diagnostic criteria, laboratory tests, and treatment options. This resource provides valuable insights for healthcare professionals, medical coders, and clinicians seeking accurate and up-to-date information on PCOS management and documentation in electronic health records (EHR). Explore resources related to hirsutism, amenorrhea, infertility, and metabolic syndrome associated with PCOS.

Also known as

PCOS
Stein-Leventhal Syndrome
Polycystic Ovarian Disease

Diagnosis Snapshot

Key Facts
  • Definition : Hormonal disorder causing irregular periods, excess androgens, and ovarian cysts.
  • Clinical Signs : Irregular or absent periods, acne, hirsutism, weight gain, infertility.
  • Common Settings : Primary care, endocrinology, gynecology, fertility clinics.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC E28.2 Coding
E28.2

Polycystic ovary syndrome

Hormonal disorder causing enlarged ovaries with small cysts.

E28.8

Other ovarian dysfunction

Ovarian disorders not elsewhere classified, potentially related to PCOS.

N97

Female infertility

Infertility related to female reproductive organs, sometimes a consequence of PCOS.

E34.8

Other endocrine disorders

General endocrine issues that may overlap with PCOS symptoms or complications.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the diagnosis Polycystic Ovary Syndrome (PCOS)?

  • Yes

    Is the PCOS associated with infertility?

  • No

    Do not code E28.2. Code the presenting condition.

Code Comparison

Related Codes Comparison

When to use each related code

Description
Hormonal disorder causing irregular periods, excess hair growth, acne.
Absent or infrequent menstruation unrelated to pregnancy or menopause.
Excessive male pattern hair growth in women.

Documentation Best Practices

Documentation Checklist
  • PCOS diagnosis: Rotterdam criteria documented
  • Two of three criteria required: oligo/anovulation, hyperandrogenism (clinical or biochemical), polycystic ovaries on ultrasound
  • Exclude other androgen-excess disorders (e.g., thyroid, CAH)
  • Specific symptoms documented (irregular menses, hirsutism, acne)
  • Relevant lab results (e.g., LH, FSH, testosterone, DHEAS)

Coding and Audit Risks

Common Risks
  • Code Sequencing

    Incorrect sequencing of PCOS diagnosis with manifestations like infertility or hirsutism can impact reimbursement and data accuracy. Medical coding and CDI should ensure proper code hierarchy.

  • Unspecified PCOS

    Using unspecified PCOS codes (e.g., E28.2) when more specific documentation is available leads to lower reimbursement and inaccurate reporting. CDI can clarify documentation for specific type.

  • Missed Manifestations

    Failing to code associated PCOS manifestations like menstrual irregularities, acne, or obesity undercodes severity and complexity. CDI should query physicians for complete documentation of all symptoms.

Mitigation Tips

Best Practices
  • Document detailed menstrual history, hirsutism, acne for PCOS ICD-10 coding (E28.2).
  • Use standardized terminology for PCOS ultrasound findings: follicle count, ovarian volume.
  • Check LH/FSH ratio, androgen levels for accurate PCOS diagnosis, avoid HCC coding errors.
  • Ensure medical necessity for PCOS treatments (metformin, OCPs) in clinical documentation.
  • Regularly audit PCOS documentation for CDI, optimize E/M coding, ensure compliance.

Clinical Decision Support

Checklist
  • Rotterdam Criteria: 2 of 3 met? (Ovulatory dysfunction, Hyperandrogenism, Polycystic ovaries)
  • Exclude other androgen-excess disorders (ICD-10 E25.0, E28.2)
  • Document LH/FSH ratio, if obtained (SNOMED CT 365758001)
  • Consider metabolic syndrome evaluation (ICD-10 E88.8)
  • Patient education on PCOS implications documented (SNOMED CT 312737002)

Reimbursement and Quality Metrics

Impact Summary
  • Polycystic Ovary Syndrome reimbursement relies accurate ICD-10 E28.2 coding, impacting claim denial rates.
  • PCOS diagnosis coding quality metrics affect hospital case mix index and risk adjustment scores.
  • Proper E28.2 code use with PCOS treatment codes (hormonal, infertility) maximizes reimbursement.
  • PCOS documentation specificity improves medical coding accuracy for quality reporting and revenue cycle.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code primary PCOS E28.2
  • Document clinical criteria
  • Rule out other causes
  • Specify phenotype if known
  • Use additional codes for manifestations

Documentation Templates

Patient presents with symptoms suggestive of Polycystic Ovary Syndrome (PCOS), including irregular periods (oligomenorrhea), hirsutism (excess hair growth), and acne.  She reports a history of menstrual irregularities since menarche, with cycles ranging from 35-60 days.  Patient denies any current use of hormonal contraception.  Physical examination reveals mild hirsutism on the face and chest, along with several comedones on the face and back.  Abdominal examination is unremarkable.  Pelvic ultrasound findings indicate polycystic ovaries, meeting the Rotterdam criteria for PCOS diagnosis.  Laboratory evaluation reveals elevated androgen levels, specifically testosterone and free testosterone, with normal DHEA-S.  Fasting glucose and lipid panel are within normal limits.  Differential diagnoses considered include idiopathic hirsutism, congenital adrenal hyperplasia, and androgen-secreting tumors, but based on clinical presentation and laboratory results, PCOS is the most likely diagnosis.  The patient was counseled on lifestyle modifications, including diet and exercise, for weight management and improvement of insulin sensitivity.  She was also informed about the potential long-term health risks associated with PCOS, such as type 2 diabetes and cardiovascular disease.  Treatment options, including metformin for insulin resistance and combined oral contraceptives for menstrual regulation and hirsutism management, were discussed.  The patient will be scheduled for follow-up in three months to monitor treatment progress and address any further concerns.  ICD-10 code E28.2 (Polycystic ovarian syndrome) is assigned.