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Q55.4 ICD-10-CM Code: Other congenital malformations of vas deferens, epididymis, seminal vesicles and prostate

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
3 inclusion terms · 4 Excludes1

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 729 — OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC (MDC 12)
  • MS-DRG 730 — OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC (MDC 12)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for Q55.4 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on Q55.4 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Absence or aplasia of prostate
  • Absence or aplasia of spermatic cord
  • Congenital malformation of vas deferens, epididymis, seminal vesicles or prostate NOS

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Coder workflow for Q55.4

MedCoder structured workflow — derived from this code’s own official record

Before you code Q55.4

  1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on Q55.4; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    ReviewQ55.0, Q55.1, Q55.3, Q55.5, Q55.7

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with Q55.4. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in Q55.4’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewP83.5, Q54, E34.5

Consider Q55.4. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting Q55.4(4 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with Q55.4: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareP83.5, Q54, E34.5

    See the official tabular notes · Guidelines I.A.12.a

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition Q55.4 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewP83.5, Q54, E34.5

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Other congenital malformations of vas deferens, epididymis, seminal vesicles and prostate is a billable ICD-10-CM diagnosis code (Q55.4).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (47)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 2 MS-DRGs: DRG 729 (MDC 12), DRG 730 (MDC 12).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):MAL003 — Genitourinary congenital anomalies (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Genitourinary congenital anomalies).

Q54.8 — Other hypospadias, Q54.9 — Hypospadias, unspecified, Q55.0 — Absence and aplasia of testis, Q55.1 — Hypoplasia of testis and scrotum, Q55.20 — Unspecified congenital malformations of testis and scrotum, Q55.21 — Polyorchism, Q55.22 — Retractile testis, Q55.23 — Scrotal transposition, Q55.29 — Other congenital malformations of testis and scrotum, Q55.3 — Atresia of vas deferens, Q55.5 — Congenital absence and aplasia of penis, Q55.61 — Curvature of penis (lateral), Q55.62 — Hypoplasia of penis, Q55.63 — Congenital torsion of penis, Q55.64 — Hidden penis, Q55.69 — Other congenital malformation of penis, Q55.7 — Congenital vasocutaneous fistula, Q55.8 — Other specified congenital malformations of male genital organs, Q55.9 — Congenital malformation of male genital organ, unspecified, Q56.0 — Hermaphroditism, not elsewhere classified, +137 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Agenesis”, “Hypoplasia, hypoplastic”, “Cyst”, …; these codes share that main term but sit in a different category of the Tabular List.

Q52.0 — Congenital absence of vagina (vagina), Q52.3 — Imperforate hymen (hymen), Q52.4 — Other congenital malformations of vagina (hymen), Q52.5 — Fusion of labia (labium, congenital), Q52.6 — Congenital malformation of clitoris (clitoris), Q52.70 — Unspecified congenital malformations of vulva (vulva), Q52.71 — Congenital absence of vulva (vulva), Q52.79 — Other congenital malformations of vulva (vulva), Q52.8 — Other specified congenital malformations of female genitalia (round ligament), Q52.9 — Congenital malformation of female genitalia, unspecified (genitourinary NEC, female), Q60.0 — Renal agenesis, unilateral (renal, unilateral), Q60.1 — Renal agenesis, bilateral (renal, bilateral), Q60.2 — Renal agenesis, unspecified (renal), Q60.3 — Renal hypoplasia, unilateral (kidney, unilateral), Q60.4 — Renal hypoplasia, bilateral (kidney, bilateral), Q60.5 — Renal hypoplasia, unspecified (kidney), Q61.00 — Congenital renal cyst, unspecified (kidney, congenital), Q61.01 — Congenital single renal cyst (kidney, solitary, congenital), Q61.02 — Congenital multiple renal cysts (kidney, more than one), Q61.11 — Cystic dilatation of collecting ducts (kidney, more than one, specified as polycystic, infantile type NEC, collecting duct dilation), +987 more

Contextual Map

Every relationship of Q55.4 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 12 — Diseases and Disorders of the Male Reproductive System[MDC crossing]: “Diseases and Disorders of the Male Reproductive System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,964 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries (47)

  • Absence (of) (organ or part) (complete or partial), ejaculatory duct (congenital)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Absence (of) (organ or part) (complete or partial), epididymis (congenital)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Absence (of) (organ or part) (complete or partial), prostate (acquired), congenital[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Absence (of) (organ or part) (complete or partial), seminal vesicles (congenital)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Absence (of) (organ or part) (complete or partial), spermatic cord, congenital[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Absence (of) (organ or part) (complete or partial), vas deferens (congenital)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Adhesions, adhesive (postinfective), spermatic cord (acquired), congenital[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Agenesis, ejaculatory duct[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • and 39 more

Nearest codes (20)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Other congenital malformations of vas deferens, epididymis, seminal vesicles and prostate

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to Q55.4 in its code family, with their registry titles.

View all codes in the Q55 family