Pediatric Coding Alert

Question: Our pediatrician wants to use diagnosis code 257.8 for a 15-year-old female. Should I use this code for males only? California Subscriber Answer: Yes, you should reserve 257.8 (Testicular dysfunction; other testicular dysfunction) for males. ICD-9 designates the code as a male-only diagnosis for Medicare purposes, which means that Medicare Outpatient Code Editor will reject 257.8 for a female patient. Even though you're probably dealing with a private payer, the insurer may implement edits similar to Medicare's.  Your pediatrician may instead want to consider 255.2  (Disorders of adrenal glands; androgenital disorders).  Code 255.2, like 257.8, includes pseudohermaphroditism, a congenital condition in which a person has external genitalia of one sex and internal sex organs of the other sex. But 255.2, unlike 257.8, isn't a gender-specific code. Another diagnostic possibility is that the patient appears female but has no uterus. In this case, the patient may be a male who has complete testicular  feminization. You should report testicular feminization syndrome as 257.8, which includes Goldberg-Maxwell syndrome, testicular feminization, and male pseudohermaphroditism with testicular feminization.