2025 ICD-10-CM code N80.9
Endometriosis of unspecified site.
Medical necessity for services related to N80.9 is established by the patient’s symptoms and clinical findings suggestive of endometriosis. This includes pelvic pain, dysmenorrhea, heavy bleeding, and infertility.Further investigations, like ultrasound, MRI, or laparoscopy, may be medically necessary to confirm the diagnosis and determine the location of the endometrial tissue. Treatment for endometriosis, such as pain management, hormone therapy, or surgery, is medically necessary when the condition significantly impacts the patient's quality of life.
The physician is responsible for diagnosing endometriosis through a thorough clinical examination, possibly including imaging studies (like ultrasound or MRI) and/or laparoscopy to visually confirm the presence of endometrial tissue outside the uterus.When the specific location is unclear, the physician may perform additional investigations or refer the patient to a specialist for further evaluation and to determine the most effective treatment strategy.
- XIV Diseases of the genitourinary system (N00-N99)
- N80-N98 Noninflammatory disorders of female genital tract
In simple words: This code represents a diagnosis of endometriosis where the exact location is unknown.
Endometriosis, unspecified
Example 1: A 32-year-old female patient presents with chronic pelvic pain, dysmenorrhea, and heavy menstrual bleeding. After initial examination and imaging studies, the physician suspects endometriosis, but the exact location cannot be definitively identified.The physician documents "endometriosis, unspecified" and uses code N80.9., A patient undergoes a laparoscopy for suspected endometriosis. The surgeon finds endometrial tissue, but its location is unusual and doesn't align with typical locations like ovaries or fallopian tubes. Biopsy confirms endometriosis, but further investigation is needed to specify the affected organ(s). The surgeon initially codes the condition as N80.9., A patient with symptoms suggestive of endometriosis undergoes an ultrasound, which reveals a possible lesion.However, the imaging is inconclusive about the nature and precise location of the lesion.The physician assigns code N80.9 and recommends further evaluation, such as an MRI or laparoscopy, to confirm the diagnosis and specify the site of endometriosis.
Documentation should include detailed descriptions of the patient's symptoms, findings from physical examinations, imaging studies (if performed), and any surgical procedures. If laparoscopy or biopsy was conducted, the operative report and pathology results should be included. The documentation should clearly state that the site of endometriosis is not specified or unknown to support the use of code N80.9.If a more specific location is identified later, the code should be updated accordingly.
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