What ICD-10 code should be used for low testosterone (male hypogonadism)?

ICD-10 Coding for Low Testosterone (Male Hypogonadism)

The appropriate ICD-10 code for low testosterone in males is E29.1 (Testicular hypogonadism) for primary hypogonadism or E23.0 (Hypopituitarism) for secondary hypogonadism, depending on the underlying etiology.

Diagnostic Requirements Before Coding

Before assigning an ICD-10 code for hypogonadism, you must confirm the diagnosis with:

• Two separate fasting morning total testosterone measurements (8-10 AM) both < 300 ng/dL to establish biochemical hypogonadism, as single measurements are insufficient due to diurnal variation and assay variability 1, 2
• Measurement of serum LH and FSH after confirming low testosterone to differentiate primary (elevated LH/FSH) from secondary (low or inappropriately normal LH/FSH) hypogonadism 2, 3
• Presence of specific symptoms such as diminished libido or erectile dysfunction, as diagnosis requires both biochemical confirmation and appropriate clinical features 1, 2

Primary ICD-10 Codes

E29.1 - Testicular Hypogonadism (Primary/Hypergonadotropic Hypogonadism)

Use this code when:

• Testosterone is low AND LH/FSH are elevated, indicating primary gonadal failure where the testes cannot respond to gonadotropin stimulation 2
• The gonads are intrinsically damaged and unresponsive to hormonal manipulation 2
• Common causes include Klinefelter syndrome, testicular trauma, chemotherapy, or radiation 2

E23.0 - Hypopituitarism (Secondary/Hypogonadotropic Hypogonadism)

Use this code when:

• Testosterone is low AND LH/FSH are low or inappropriately normal, indicating impaired hypothalamic-pituitary function 2, 4
• The gonads are structurally intact and capable of responding to gonadotropin stimulation 2
• Common acquired causes include exogenous testosterone/anabolic steroids, opiates, cranial/pituitary radiation, hyperprolactinemia, type 2 diabetes, and obesity 2

Additional Relevant Codes

• E29.8 - Other testicular dysfunction (for unspecified or atypical presentations)
• E29.9 - Testicular dysfunction, unspecified (when etiology is unclear)
• N46.0 - Azoospermia (if fertility impairment is documented)
• E28.39 - Other primary ovarian failure (for female hypogonadism, not male)

Critical Coding Considerations

• Never code based on symptoms alone without biochemical confirmation of low testosterone on two separate morning measurements 1, 2
• Always obtain LH/FSH levels after confirming low testosterone, as the primary versus secondary distinction is essential for proper coding and directs treatment choice 2, 3
• Do not code age-related testosterone decline as hypogonadism unless both biochemical criteria (testosterone < 300 ng/dL) and specific symptoms are present 1
• Approximately 20-30% of men receiving testosterone therapy do not meet diagnostic criteria for hypogonadism, highlighting the importance of proper documentation before coding 1

Documentation Requirements for Coding

Your medical record should include:

• Two morning testosterone values < 300 ng/dL measured between 8-10 AM on separate occasions 1, 2
• LH and FSH levels to classify as primary or secondary 2, 3
• Specific symptoms such as diminished libido, erectile dysfunction, or decreased spontaneous erections 1, 2
• Exclusion of reversible causes such as medications (opiates, corticosteroids), obesity, metabolic syndrome, or chronic illness 2, 5

Common Pitfalls to Avoid

• Do not code hypogonadism based on a single testosterone measurement, as this leads to misclassification 1, 2
• Do not assign E29.1 or E23.0 without measuring LH/FSH, as the distinction between primary and secondary hypogonadism is critical for treatment and fertility counseling 2, 3
• Do not code for nonspecific symptoms like fatigue, low energy, or mood changes alone, as these show minimal correlation with testosterone levels and do not improve reliably with therapy 1
• Avoid coding in men with borderline testosterone (231-346 ng/dL) unless free testosterone is also measured and confirms true hypogonadism 1