2025 ICD-10-CM code N36.42
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Other diseases of the urinary system - Urethral functional and muscular disorders Diseases of the genitourinary system (N00-N99) Feed
Intrinsic sphincter deficiency (ISD) is a condition affecting the urethra's ability to maintain continence.
Modifiers may apply depending on the procedure or service rendered. Consult appropriate guidelines and payer requirements for applicable modifiers.
Medical necessity for the diagnosis and treatment of ISD is established by the presence of symptoms of stress urinary incontinence, confirmed by a proper diagnostic workup.The severity and impact on quality of life should be documented to justify the medical necessity of any interventions.
The clinical responsibility for diagnosing and treating ISD involves a comprehensive evaluation by a urologist, urogynecologist, or other qualified healthcare professional.This includes taking a detailed history, performing a physical examination (including a pelvic exam), and potentially ordering additional diagnostic tests such as urodynamic studies (cystometry, urethral pressure profilometry) to confirm the diagnosis and assess the severity of the condition.
In simple words: Intrinsic sphincter deficiency (ISD) is a problem with the muscle that keeps urine from leaking out.It makes it hard to hold urine, especially when coughing, sneezing, or exercising.
Intrinsic sphincter deficiency (ISD) is a functional disorder of the urethra characterized by inadequate closure of the urethral sphincter, leading to urinary incontinence, typically stress incontinence.This deficiency is often associated with female urinary stress incontinence and results from an inability of the urethral sphincter to maintain continence against increased abdominal pressure.The condition may be diagnosed through a comprehensive evaluation including history, physical examination (including pelvic exam), and urodynamic studies like cystometry.
Example 1: A 55-year-old female patient presents with stress urinary incontinence after childbirth.Physical examination and urodynamic studies reveal ISD.The physician codes N36.42 for ISD., A 60-year-old female patient complains of urinary leakage with coughing and sneezing.Evaluation including cystometry reveals ISD as the primary cause of her stress incontinence. The physician codes N36.42 and may also code N39.3 for stress incontinence., A 40-year-old female patient undergoes a urethral bulking injection procedure for the treatment of ISD (N36.42).The physician also codes the appropriate CPT code for the injection procedure and the HCPCS code for the injected material.
Comprehensive history and physical examination, including a pelvic examination.Documentation of urodynamic studies (such as cystometry and/or uroflowmetry) confirming ISD and assessing the severity of the condition.Details of any prior treatments and their outcomes. If treatment was performed, detailed procedure notes should be available.
** The diagnosis of ISD requires a thorough evaluation to rule out other causes of urinary incontinence.Accurate documentation of the diagnostic process is crucial for proper coding and reimbursement.
- Revenue Code: This will vary depending on the specific services rendered and the payer.
- RVU: Relative Value Units (RVUs) are not assigned to ICD-10 codes.RVUs are associated with CPT codes for procedures performed to treat the condition, such as urethral bulking (CPT 51715) which may have associated RVUs and HCPCS codes for materials (e.g., L8606).
- Global Days: Not applicable to ICD-10 codes.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes. Technical component modifiers apply to CPT codes for procedures.
- Fee Schedule: Not applicable to ICD-10 codes. Fee schedules apply to CPT codes for procedures and HCPCS codes for materials.
- Specialties:Urology, Urogynecology
- Place of Service:Office, Hospital (inpatient or outpatient), Ambulatory Surgical Center