What ICD10 (International Classification of Diseases, 10th Revision) codes support medical necessity for male testosterone screening?

ICD-10 Codes Supporting Medical Necessity for Male Testosterone Screening

The primary ICD-10 codes that support medical necessity for male testosterone screening are those that document symptoms of hypogonadism, including decreased libido, erectile dysfunction, fatigue, and depression, as well as conditions known to be associated with low testosterone. 1

Primary Diagnostic Codes for Testosterone Screening

Symptoms of Hypogonadism

• E29.1 - Testicular hypofunction
• N50.0 - Testicular atrophy
• F52.0 - Hypoactive sexual desire disorder
• F52.21 - Erectile dysfunction
• R53.83 - Other fatigue
• F32.9 - Major depressive disorder, single episode, unspecified

Associated Medical Conditions

• E11.x - Type 2 diabetes mellitus (various codes depending on complications) 1
• E66.x - Obesity (various codes depending on type) 1
• B20 - HIV disease 1
• K70-K77 - Chronic liver disease 1
• M80.x-M81.x - Osteoporosis with or without pathological fracture 1

Clinical Indications for Testosterone Screening

According to the AUA Guideline on Testosterone Deficiency 1, testosterone screening is medically necessary in men with:

1. Specific symptoms and signs:

   • Decreased libido/sexual desire
   • Erectile dysfunction
   • Reduced bone mass or low trauma fractures
   • Hot flashes or sweats
   • Fatigue or depressive symptoms (less specific)

2. High-risk conditions:

   • Type 2 diabetes (men with diabetes have lower mean testosterone levels) 1
   • HIV infection (especially those on antiretroviral therapy) 1
   • Chronic liver disease 1
   • Chronic opioid use
   • Chronic corticosteroid use

Testing Protocol for Medical Necessity Documentation

To properly document medical necessity:

1. Morning serum total testosterone should be the initial test 1

   • Must be drawn in the morning due to diurnal variation
   • Document time of collection

2. Repeat testing is required to confirm low levels 1

   • A single low value is insufficient for diagnosis
   • Document consistent pattern of low values

3. Additional testing when total testosterone is borderline:

   • Free testosterone or bioavailable testosterone
   • Sex hormone binding globulin (SHBG)
   • Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to determine primary vs. secondary hypogonadism

Important Considerations

• The FDA has not approved testosterone therapy for "age-related hypogonadism" or "late-onset hypogonadism" 2
• Normal testosterone ranges vary by age; younger men (20-44 years) typically have higher reference ranges than older men 3
• Screening should be targeted at symptomatic men rather than used as a general screening test
• Documentation must clearly connect symptoms to the possibility of testosterone deficiency

Pitfalls to Avoid

1. Inadequate documentation - Ensure symptoms are clearly documented in the medical record
2. Inappropriate timing - Testosterone should be measured in the morning when levels are highest
3. Single testing - A single low value is insufficient; confirmation with repeat testing is required
4. Missing associated conditions - Document any conditions known to be associated with low testosterone
5. Age considerations - Consider age-specific reference ranges when interpreting results 3

By properly documenting both symptoms and relevant medical conditions using appropriate ICD-10 codes, medical necessity for testosterone screening can be established, improving the likelihood of coverage for this diagnostic test.