Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesCongenital malformations of genital organsICD-10-CM q56-indeterminate-sex-and-pseudohermaphroditism
    Ask Trek AI about this page

    ICD-10-CM Code For Indeterminate Sex And Pseudohermaphroditism: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group Q56 includes congenital conditions characterized by indeterminate sex and pseudohermaphroditism, covering disorders of sexual development and atypical genital formation. These ICD-10-CM diagnosis codes are used to document congenital genital organ malformations, capture anatomical and developmental involvement, and note clinical complexity in newborns and pediatric patients. Accurate coding within the ICD-10-CM Q56 group supports proper claim adjudication and complete clinical documentation for appropriate reimbursement.

    Customize your policy alerts

    Sign up for ICD-10-CM Code For Indeterminate Sex And Pseudohermaphroditism: Group Overview policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    ICD-10-CM Q56: Indeterminate Sex And Pseudohermaphroditism Overview

    This group captures congenital conditions where chromosomal, gonadal, or phenotypic sex is ambiguous or where external genitalia do not match typical male or female development. It targets congenital malformations of the genital organs and disorders of sexual development present at birth. Accurate coding is important for clinical documentation and impacts coding-based reimbursement and resource allocation.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    When to Use

    Use a code from this group when documenting a newborn or pediatric patient with ambiguous genitalia, disorders of sex development, or identified pseudohermaphroditism based on clinical assessment and diagnostic findings. Codes in this group are appropriate when the primary clinical concern is congenital atypical development of the genital organs requiring classification for care, monitoring, or administrative purposes.

    ICD-10-CM Codes

    5 rows

    ICD-10-CM CodeDescription
    Q56.0Hermaphroditism, not elsewhere classified
    Q56.1Male pseudohermaphroditism, not elsewhere classified
    Q56.2Female pseudohermaphroditism, not elsewhere classified
    Q56.3Pseudohermaphroditism, unspecified
    Q56.4Indeterminate sex, unspecified

    DRG Codes

    6 rows

    DRG CodeDescription
    729Other Male Reproductive System Diagnoses with CC/MCC
    730Other Male Reproductive System Diagnoses without CC/MCC
    742Uterine and Adnexa Procedures for Non-Malignancy with CC/MCC
    743Uterine and Adnexa Procedures for Non-Malignancy without CC/MCC
    760Menstrual and Other Female Reproductive System Disorders with CC/MCC
    761Menstrual and Other Female Reproductive System Disorders without CC/MCC

    Typical Clinical Scenarios

    • A newborn with ambiguous external genitalia is evaluated in the neonatal unit after delivery; the infant presents with atypical genital morphology and unclear sex assignment on physical exam, prompting endocrine, genetic, and urologic assessment to determine underlying disorder of sex development. A congenital malformation code from this group is assigned to document indeterminate sex/pseudohermaphroditism as part of the diagnostic workup and initial problem list. Typical codes: Q56.0, Q56.1
    • An adolescent assigned female at birth presents to pediatric endocrinology for primary amenorrhea and virilization with clitoromegaly and ambiguous genital features identified on prior childhood records; evaluation includes karyotype and hormone studies to characterize a congenital intersex condition established earlier but newly being managed for pubertal development. A code from this group is used to capture the congenital pseudohermaphroditism/indeterminate sex as the underlying diagnosis guiding long-term endocrine and surgical planning. Typical codes: Q56.2, Q56.3
    • An adult with a known congenital intersex condition is admitted for reconstructive genital surgery due to urinary obstruction and recurrent infections related to atypical urethral anatomy; perioperative documentation requires coding of the congenital genital malformation as a comorbidity contributing to the current complication and surgical approach. A code from this group is recorded to reflect the structural congenital anomaly influencing treatment and postoperative care. Typical codes: Q56.4, Q56.1}

    Related Codes

    Q50-CONGENITAL-MALFORMATIONS-OF-OVARIES

    ICD-10-CM Code For Congenital Malformations Of Ovaries Fallopian Tubes And Broad Ligaments: Group Overview

    Q51-CONGENITAL-MALFORMATIONS-OF-UTERUS-AND-CERVIX

    ICD-10-CM Code For Congenital Malformations Of Uterus And Cervix: Group Overview

    Q52-OTHER-CONGENITAL-MALFORMATIONS-FEMALE-GENITALIA

    ICD-10-CM Code For Other Congenital Malformations Of Female Genitalia: Group Overview

    Q53-UNDESCENDED-AND-ECTOPIC-TESTICLE

    ICD-10-CM Code For Undescended And Ectopic Testicle: Group Overview

    Q54-HYPOSPADIAS

    ICD-10-CM Code For Hypospadias: Group Overview

    Q55-OTHER-CONGENITAL-MALE-GENITAL-MALFORMATIONS

    ICD-10-CM Code For Other Congenital Malformations Of Male Genital Organs: Group Overview

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.