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I86.1
ICD-10-CM
Varicocele

Find comprehensive information on varicocele diagnosis including clinical documentation, medical coding, ICD-10 codes (N43.4), CPT codes for varicocelectomy (55560, 55562), and ultrasound imaging. Learn about symptoms, treatment options, and post-operative care for varicocele. This resource provides healthcare professionals with accurate and relevant information for proper diagnosis and billing related to varicocele.

Also known as

Scrotal varices
Pampiniform plexus dilation

Related ICD-10 Code Ranges

Complete code families applicable to AAPC I86.1 Coding
N50-N51

Diseases of male genital organs

Covers conditions affecting the male reproductive system.

I86-I87

Diseases of veins, lymphatic vessels

Includes various vein and lymphatic system disorders.

R20-R29

Symptoms and signs involving skin

Encompasses visible skin changes and related symptoms.

Code-Specific Guidance

Decision Tree for

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

Is the varicocele symptomatic?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Enlarged veins in scrotum
Fluid collection in scrotum
Testicular torsion

Documentation Best Practices

Documentation Checklist
  • Varicocele diagnosis documented
  • Laterality (left, right, bilateral) specified
  • Physical exam findings: palpable pampiniform plexus
  • Symptom documentation: pain, swelling, infertility
  • Imaging confirmation (ultrasound) if performed

Coding and Audit Risks

Common Risks
  • Laterality Coding

    Missing or incorrect laterality (right, left, bilateral) for varicocele impacts reimbursement and data accuracy. CDI can query for clarity.

  • Symptom vs. Diagnosis

    Coding symptoms like scrotal pain instead of the confirmed diagnosis of varicocele leads to underreporting and inaccurate clinical data.

  • Unspecified Varicocele

    Using unspecified codes when a more specific diagnosis (e.g., primary, secondary) is documented impacts quality reporting and payment.

Mitigation Tips

Best Practices
  • Document Varicocele laterality (ICD-10-CM N43.0, N43.1) for accurate coding.
  • Precise CDI: Palpable exam findings improve Varicocele diagnosis coding specificity.
  • Regular audits ensure correct Varicocele ICD-10 coding compliance.
  • Use standardized terminology (e.g., grade, size) for Varicocele documentation.
  • Correlate ultrasound findings with physical exam for optimal Varicocele diagnosis.

Clinical Decision Support

Checklist
  • 1. Palpate spermatic cord for dilated veins (ICD-10: I86.1)
  • 2. Valsalva maneuver to accentuate varicocele (SNOMED CT: 40049004)
  • 3. Document size, location, laterality (CPT: 55560)
  • 4. Consider scrotal ultrasound for subclinical cases (LOINC: 24612-6)
  • 5. Rule out secondary causes (e.g., renal mass) (Patient Safety)

Reimbursement and Quality Metrics

Impact Summary
  • Varicocele reimbursement: CPT 55560, 55565 impact payment. ICD-10 N43.4, N43.3 crucial for coding accuracy.
  • Quality metrics: Post-op pain, hydrocele rate, recurrence influence hospital reporting and value-based care.
  • Denial risk: Proper documentation of varicocele size, laterality (unilateral, bilateral) essential.
  • Coding tip: Embolization versus surgery impacts coding (e.g., 37618, 36471) and reimbursement levels.

Streamline Your Medical Coding

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

Quick Tips

Practical Coding Tips
  • Code primary varicocele I86.1
  • Laterality: Use L90.4-.5
  • Symptom coding impacts severity
  • Document exam findings clearly
  • Consider duplex ultrasound codes

Documentation Templates

Patient presents with complaints consistent with varicocele symptoms, including scrotal pain, testicular pain, or a feeling of heaviness or fullness in the scrotum.  Physical examination reveals a palpable, non-tender mass described as a "bag of worms" in the left scrotum, consistent with a clinical diagnosis of varicocele.  The right scrotum is unremarkable.  Differential diagnoses considered include spermatocele, hydrocele, and inguinal hernia.  Assessment includes evaluation for male infertility, as varicoceles can impact sperm production.  Treatment options discussed include watchful waiting, varicocele embolization, and varicocelectomy.  Patient education provided regarding varicocele causes, varicocele grading (Grade I, Grade II, Grade III), and potential complications such as testicular atrophy and infertility.  Patient understands risks and benefits of each treatment option and will follow up for further evaluation.  ICD-10 code N45.40 (Varicocele of unspecified testicle) and relevant CPT codes for procedures, if performed, will be documented.  This documentation supports medical necessity for evaluation and management of varicocele and any subsequent interventions.