2025 ICD-10-CM code N82.5
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the genitourinary system - Noninflammatory disorders of female genital tract Diseases of the genitourinary system (N00-N99) Feed
Female genital tract-skin fistulae; a connection between the female genital tract and the skin.
Modifiers may be applicable depending on the circumstances of the procedure.Consult current modifier guidelines for appropriate modifier use.
Medical necessity for N82.5 is established by the presence of a clinically significant fistula between the female genital tract and the skin, causing symptoms such as leakage of urine, feces, or other materials, or other clinical symptoms warranting surgical or medical intervention.The medical necessity should be clearly documented, outlining the reasons for the proposed treatment and its clinical impact.
The clinical responsibility involves the diagnosis and treatment of the fistula.This may include imaging studies (e.g., MRI, CT, ultrasound) to assess the location and extent of the fistula. Treatment might involve surgical repair, sometimes requiring multiple procedures depending on the complexity of the fistula. Post-operative care and follow-up are also essential aspects of the clinical responsibility.
- Diseases of the genitourinary system (N00-N99)
- N80-N98 (Noninflammatory disorders of female genital tract)
In simple words: This code describes an abnormal connection between the vagina, cervix, or uterus and the skin. This connection, called a fistula, can leak fluids or other substances.It may result from injury, surgery, or infection.
N82.5, Female genital tract-skin fistulae, refers to an abnormal passage (fistula) that forms between the female genital tract (vagina, cervix, uterus) and the skin.This can result from various causes including trauma, surgery, infection, or radiation. The fistula allows for the abnormal passage of fluids or other substances between these two areas.Specific examples include a fistula between the uterus and the abdominal wall or a vaginoperineal fistula (between the vagina and perineum).
Example 1: A 45-year-old female presents with a history of a difficult vaginal delivery resulting in a vesicovaginal fistula.This requires surgical repair, coded as N82.5. , A 60-year-old woman with a history of cervical cancer undergoes radiation therapy.Later, she develops a rectovaginal fistula as a complication, requiring surgical intervention. This is also coded as N82.5., A 32-year-old woman sustained a significant pelvic injury in a motor vehicle accident, resulting in a uterine-abdominal wall fistula. Surgical repair is required, coded N82.5.
Detailed patient history, including the onset and progression of symptoms, any relevant prior surgeries or medical conditions, and details of the physical examination findings.Imaging reports (e.g., MRI, CT scans, ultrasound), operative notes describing the surgical repair (including type of fistula, surgical approach, and extent of repair), and pathology reports (if applicable) are required.Progress notes documenting post-operative recovery and any complications should also be included.
** Always ensure that the documentation supports the code assigned and aligns with the official ICD-10-CM coding guidelines to prevent claim denials.Clarification on the specific type of fistula and associated symptoms might be needed for appropriate coding. ICD-9-CM equivalent is 619.2.
- Payment Status: Active
- Modifier TC rule: Not applicable to N82.5.
- Specialties:Obstetrics and Gynecology, Urogynecology, Colorectal Surgery, General Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center