2025 ICD-10-CM code E28.2
Polycystic ovarian syndrome (PCOS), also known as Stein-Leventhal syndrome or sclerocystic ovary syndrome.
Medical necessity for PCOS treatment is based on the patient's symptoms and potential long-term health risks associated with the condition, such as infertility, type 2 diabetes, cardiovascular disease, and endometrial hyperplasia. Treatment is aimed at managing the specific symptoms and mitigating these risks.
Diagnosis of PCOS involves assessing medical history, physical exam findings (including evaluating for hirsutism, acne), and laboratory tests (hormone levels, blood glucose, lipids). Pelvic ultrasound may be performed to assess ovaries. Management may include lifestyle modifications (diet, exercise), medications to regulate menstrual cycles, manage hyperandrogenism, and address metabolic issues. Referral to specialists (endocrinologist, reproductive endocrinologist) may be necessary.
- Endocrine, Nutritional and Metabolic Diseases (E00-E89)
- E28.2 sits within the larger block of E28, Ovarian Dysfunction (E28.0-E28.9).
In simple words: Polycystic ovary syndrome, or PCOS, is a hormonal problem that affects women during their childbearing years.It causes irregular periods, higher levels of male hormones, and small cysts on the ovaries. Symptoms can include infrequent or missed periods, excess hair growth, acne, weight gain, and difficulty getting pregnant.
Polycystic ovarian syndrome (PCOS) is a hormonal disorder common among women of reproductive age. It is characterized by a combination of symptoms related to irregular periods, elevated androgens (male hormones), and polycystic ovaries.The diagnostic criteria vary, but commonly include two out of three of the following: oligo- or anovulation (infrequent or absent ovulation), hyperandrogenism (clinical or biochemical signs of excess male hormones), and polycystic ovaries on ultrasound.Symptoms can include irregular or absent menstrual periods, hirsutism (excess hair growth), acne, weight gain, and fertility problems.The exact cause of PCOS is unknown, but it is thought to involve a combination of genetic and environmental factors.
Example 1: A 25-year-old female presents with irregular periods, acne, and excessive facial hair.Blood tests reveal elevated androgen levels, and a pelvic ultrasound shows polycystic ovaries. She is diagnosed with E28.2, Polycystic Ovarian Syndrome., A 32-year-old woman struggling with infertility undergoes a workup, which reveals irregular ovulation and polycystic ovaries. She has normal androgen levels but meets other criteria for PCOS and is coded as E28.2., A 19-year-old female with obesity, hirsutism, and infrequent menses is evaluated for PCOS. Laboratory testing shows elevated testosterone levels. She is diagnosed with PCOS and coded E28.2.
Documentation should include details of the patient's menstrual history, clinical signs of hyperandrogenism (hirsutism, acne), results of hormonal assays (LH, FSH, testosterone, DHEA-S, androstenedione), and imaging findings (pelvic ultrasound). Relevant medical history, such as obesity, insulin resistance, and family history of PCOS, should also be noted.
** Conditions excluded from E28 are isolated gonadotropin deficiency (E23.0) and postprocedural ovarian failure (E89.4-).
- Payment Status: Active
- Specialties:Endocrinology, Reproductive Endocrinology, Gynecology, Family Medicine, Internal Medicine
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital (if admitted for related complications)