Polycystic Ovarian Syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age. In the medical field, accurate diagnosis and coding are crucial for effective patient care, billing, and epidemiological tracking. The E28.2 Diagnosis Code is specifically used within the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) to classify and identify cases of Polycystic Ovarian Syndrome. This article delves into the specifics of the E28.2 code, providing a comprehensive understanding for healthcare professionals and anyone seeking information on this important diagnostic category.
What is the E28.2 Diagnosis Code?
The E28.2 code is a designated category within the ICD-10-CM system for “Polycystic ovarian syndrome.” It falls under the broader category of “Ovarian dysfunction” (E28) within the endocrine, nutritional and metabolic diseases section of the ICD-10-CM. Importantly, E28.2 is a billable/specific code, meaning it is precise enough to be used for reimbursement purposes in healthcare claims.
According to the latest updates, the 2025 ICD-10-CM E28.2 code is effective from October 1, 2024. This code is the American modification of the international ICD-10 code E28.2, and it’s essential to note that international versions may have slight variations. For coding and diagnostic accuracy within the United States, the ICD-10-CM version E28.2 is the standard.
Conditions Applicable to E28.2
The ICD-10-CM system provides clarity on what conditions are specifically classified under the e28.2 diagnosis code. These “Applicable To” notes are crucial for coders to ensure they are using the code correctly. For E28.2, the following terms are listed as applicable:
- Sclerocystic ovary syndrome: This is an older term but is still recognized as referring to PCOS.
- Stein-Leventhal syndrome: This is the classical name for Polycystic Ovarian Syndrome, named after the doctors who first described it.
These terms are essentially synonyms for PCOS and guide medical professionals to use the E28.2 code when diagnosing patients with these conditions.
Understanding Polycystic Ovarian Syndrome: Clinical Information
Polycystic Ovary Syndrome is more than just the presence of cysts on the ovaries. It’s a complex endocrine disorder characterized by hormonal imbalances that can lead to a range of symptoms and health issues. The core features of PCOS include:
- Menstrual Disturbances: Irregular periods (oligomenorrhea), absent periods (amenorrhea), and anovulation (lack of ovulation) are common.
- Hyperandrogenism: Elevated levels of androgens (male hormones) in women, which can manifest as hirsutism (excessive hair growth on the face, chest, and body), acne, and sometimes virilization (development of male physical characteristics).
- Polycystic Ovaries: While the name suggests many cysts, it’s more accurately described as ovaries containing multiple small follicles (immature eggs) that appear as “cysts” on ultrasound. However, the presence of actual cysts is not the defining diagnostic criterion, and some women with PCOS may not have polycystic ovaries on ultrasound.
- Infertility: Due to irregular ovulation or anovulation, PCOS is a leading cause of infertility in women.
- Metabolic Issues: Insulin resistance is frequently associated with PCOS, increasing the risk of type 2 diabetes, weight gain, and metabolic syndrome.
Beyond these core features, PCOS can also be associated with:
- Obesity: While not all women with PCOS are obese, it is a common comorbidity.
- Sleep Apnea: Increased risk due to hormonal and metabolic factors.
- Mental Health Issues: Higher rates of anxiety and depression are observed in women with PCOS.
- Increased Risk of Chronic Diseases: Long-term health risks include type 2 diabetes, cardiovascular disease, endometrial cancer, and non-alcoholic fatty liver disease.
It’s important to understand that PCOS presents differently in each woman. The severity of symptoms and the specific combination of features can vary widely. Diagnosis typically involves a combination of clinical evaluation, blood tests to assess hormone levels, and pelvic ultrasound.
Synonyms and Related Terms for E28.2
Understanding synonyms for the e28.2 diagnosis code can be helpful in navigating medical documentation and research. Approximate synonyms listed for E28.2 include:
- Isosexual virilization: This refers to the development of male characteristics in females due to hormonal imbalances.
- Polycystic ovaries: While technically not the full syndrome, it’s a key feature and often used interchangeably in common language.
- Virilization, isosexual: Similar to isosexual virilization, emphasizing the masculinizing effects.
These terms, while not perfectly precise replacements for “Polycystic Ovarian Syndrome,” are related and can be encountered in medical contexts referring to the same condition coded as E28.2.
Code History and Context within ICD-10-CM
The E28.2 code was introduced into the ICD-10-CM system in 2016, effective October 1, 2015. This indicates it was a new code at the inception of the non-draft ICD-10-CM, reflecting the increasing recognition and need for specific coding of PCOS. Since its introduction, there have been no revisions to the code itself, with “No change” noted in the code history from 2017 through 2025. This stability suggests that the E28.2 code is well-established and effectively captures Polycystic Ovarian Syndrome within the diagnostic coding framework.
The surrounding codes in the ICD-10-CM hierarchy provide context. E28 encompasses “Ovarian dysfunction,” and codes adjacent to E28.2 address other specific ovarian disorders, such as:
- E28.0 – Estrogen excess
- E28.1 – Androgen excess (other than PCOS)
- E28.3 – Primary ovarian failure
- E28.8 – Other ovarian dysfunction
- E28.9 – Ovarian dysfunction, unspecified
This placement highlights that E28.2, Polycystic Ovarian Syndrome, is categorized as a distinct and significant form of ovarian dysfunction characterized by hormonal imbalances, particularly androgen excess and often associated with polycystic ovaries.
Importance of Accurate E28.2 Coding
Accurate use of the e28.2 diagnosis code is essential for several reasons:
- Reimbursement: As a billable code, E28.2 ensures that healthcare providers are appropriately reimbursed for the diagnosis and management of PCOS.
- Epidemiology and Research: Consistent and accurate coding allows for tracking the prevalence and incidence of PCOS, contributing to public health statistics and research efforts.
- Patient Care Management: Correct diagnosis coding within electronic health records facilitates appropriate clinical pathways, alerts, and management strategies for patients with PCOS.
- Data Analysis: For healthcare organizations and systems, accurate coding provides valuable data for quality improvement, resource allocation, and understanding patient populations.
In conclusion, the e28.2 diagnosis code is the standardized and specific ICD-10-CM code for Polycystic Ovarian Syndrome. Understanding its application, associated conditions, clinical context, and synonyms is crucial for healthcare professionals involved in diagnosis, coding, billing, and the overall management of women’s health. For anyone seeking information on PCOS and its diagnostic classification, the E28.2 code serves as a key identifier within the medical coding system.
