ICD-10 code Q52.3: Agenesis Of Uterus

Key Takeaways

ICD-10 Code Q52.3 describes imperforate hymen, a congenital obstruction of the hymenal membrane classified under Chapter 17 (Q00-Q99) of the ICD-10-CM tabular list.

Q52.3 is a billable, female-only diagnosis code valid for dates of service October 1, 2024 through September 30, 2025 (FY2025), with no further subcode required.

Synonyms include congenital atresia of vagina and cribriform hymen; coders must distinguish Q52.3 from closely related codes such as Q52.0 (congenital absence of vagina) and Q52.4 (other congenital malformations of vagina).

Pabau’s claims management software streamlines diagnosis code entry, payer submission, and documentation workflows for OB-GYN and women’s health clinics billing Q52.3.

Most coding denials for congenital female genital malformations trace back to one problem: the coder selected a non-specific or incorrect code when a billable, specific option existed. For imperforate hymen, that specific code is ICD-10 Code Q52.3, and it covers presentations ranging from complete hymenal obstruction to cribriform and microperforate variants documented under its synonyms. Getting this right matters because payors for pediatric and adolescent gynecology encounters increasingly require a precise congenital malformation code to process reimbursement for evaluation, imaging, and surgical correction.

This reference covers Q52.3’s official definition, billability status, synonyms and inclusions, related codes in the Q52 category, documentation requirements, and the associated procedure code for surgical correction. Coders working in OB-GYN, pediatric surgery, and women’s health settings will find the clinical context and payer guidance they need here.

ICD-10 Code Q52.3: Definition, billability, and clinical description

Imperforate hymen is a congenital condition in which the hymenal membrane completely blocks the vaginal opening, preventing normal drainage of secretions or, at puberty, menstrual blood. Q52.3 is the ICD-10-CM code assigned to this condition and to its partial or variant presentations documented using the code’s synonyms. Coders and clinicians working in OB-GYN practice management software-enabled environments will find this code activates specific claim workflows tied to congenital malformation billing pathways.

The code sits within the ICD-10-CM Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99). More specifically, it falls under block Q50-Q56 (Congenital malformations of genital organs) and within the Q52 subcategory covering other congenital malformations of female genitalia.

• Code: Q52.3
• Short description: Imperforate hymen
• Code type: Billable, specific ICD-10-CM diagnosis code
• Valid FY2025 dates: October 1, 2024 through September 30, 2025
• Applies to: Female patients only
• POA reporting: Exempt from Present on Admission (POA) reporting (congenital condition)

According to the WHO’s ICD-10 browser, the WHO includes Q52.3 in the international classification of diseases under the same congenital genital organ malformation grouping, making it consistent across both the international ICD-10 and the U.S. clinical version (ICD-10-CM) used for HIPAA-covered transactions.

Q52.3 synonyms, inclusions, and variant presentations

The ICD-10-CM tabular list includes synonyms for Q52.3 that reflect clinical variants and alternative terminology in use across gynecology and pediatric surgery. Coders should know these terms to correctly apply the code when documentation uses non-standard language.

When documentation describes hematocolpos or hematometrocolpos as a presenting complication, Q52.3 remains the primary diagnosis code. Hematocolpos means blood accumulating in the vagina; hematometrocolpos means blood accumulating in both the uterus and vagina. These are results of the congenital defect, not separate conditions requiring their own primary code.

Related ICD-10 codes in the Q52 category

Selecting Q52.3 accurately requires familiarity with adjacent codes in the Q52 block. They cover closely related congenital malformations of the female genitalia. Choosing the wrong one at billing submission is a common audit trigger. The CDC/NCHS ICD-10-CM web tool is the authoritative U.S. lookup for verifying each code’s tabular definition before claim submission.

• Q52.0 – Congenital absence of vagina: Use when the vagina is entirely absent, not merely obstructed. This is a Müllerian agenesis scenario, not a hymenal defect.
• Q52.1x – Doubling of vagina: Subcodes cover longitudinal and obstructing vaginal septa; distinct from Q52.3 hymenal obstruction.
• Q52.2 – Congenital rectovaginal fistula: An abnormal communication between rectum and vagina; a separate structural defect.
• Q52.3 – Imperforate hymen: The code for this article. Hymenal obstruction, complete or cribriform.
• Q52.4 – Other congenital malformations of vagina: Use when documentation describes a vaginal malformation not captured by Q52.0-Q52.3.
• Q52.5 – Fusion of labia: Labial adhesion of congenital origin; distinct from hymenal pathology.

Coders should also be aware that Q52.3 is distinct from ICD-10 coding documentation patterns used in non-congenital acquired conditions. Acquired vaginal stenosis or post-surgical vaginal obstruction would not be coded Q52.3; congenital origin is required for this code to apply.

ICD-10 Code Q52.3 documentation requirements for billing

Payers processing claims for congenital malformation encounters expect documentation that establishes three things: the congenital nature of the condition, the specific physical location, and the clinical basis for the encounter (diagnostic, surgical, or follow-up). For Q52.3, this means the medical record must include a clear physician statement linking the obstruction to a congenital origin, not simply describing the presenting symptom such as primary amenorrhea or cyclic pelvic pain.

For encounters in fertility clinic software-supported settings where imperforate hymen is incidentally identified during infertility workup, the same documentation standard applies. The code is billable only when the physician has documented a confirmed diagnosis, not a rule-out or suspected finding.

• Required in the record: Confirmed diagnosis of imperforate hymen with congenital origin (not merely “vaginal obstruction” or “primary amenorrhea”)
• Physical examination findings: Bulging hymenal membrane, absence of visible vaginal orifice, or characteristic bluish discoloration (hematocolpos)
• Imaging if applicable: Pelvic ultrasound or MRI confirming obstruction level and presence/absence of hematocolpos
• Procedure link if surgical: CPT 56700 (hymenectomy) should be linked to Q52.3 as the supporting diagnosis when the procedure is performed
• POA status: Mark as “1” (condition present on admission) or leave exempt per your facility’s POA reporting protocol for congenital codes

The CMS ICD-10-CM coding guidelines require coders to code the confirmed diagnosis to the highest level of specificity. For Q52.3, this means using the code as documented without defaulting to Q52.4 (other) unless the physician’s documentation genuinely does not specify whether the malformation is hymenal or involves a separate vaginal structural defect.

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ICD-9-CM to ICD-10-CM crosswalk for Q52.3

Practices reviewing old claims or auditing legacy records may need to cross-reference Q52.3 against the retired ICD-9-CM system. The transition to ICD-10-CM occurred on October 1, 2015. The predecessor code for imperforate hymen was ICD-9-CM 752.42. The predecessor code for imperforate hymen was ICD-9-CM 752.42, which covered imperforate hymen as a congenital anomaly of the external female genitalia.

For practices responding to payer audits covering pre-2015 service dates, this crosswalk confirms Q52.3 is the precise equivalent of the retired 752.42 code. Using Q52.4 instead would introduce a specificity mismatch. That mismatch could flag during comparative billing reviews. The diagnostic code reference pattern used for congenital conditions applies here: default to the most specific code documented, not the unspecified fallback.

Associated CPT procedure code: Hymenectomy and Q52.3

Surgical correction of imperforate hymen requires hymenectomy, the excision of the obstructing hymenal membrane. Surgeons bill CPT 56700 (Hymenotomy, simple incision) for incision and drainage, or CPT 56442 (Hymenectomy, simple, with surgical closure) depending on what the documentation supports and payer policy requires. Coders should verify current CPT descriptors against the AMA code set for each procedure year.

When a hymenectomy is performed, Q52.3 functions as the primary ICD-10 diagnosis code linking medical necessity for the procedure. Claims that omit Q52.3 (or an equivalent specific congenital code) as the supporting diagnosis risk denial on medical necessity grounds, particularly for pediatric encounters where payers may require explicit documentation of congenital origin rather than a symptom-based code such as N76.x (vulvovaginitis) or N94.x (dysmenorrhea).

Practices offering surgical services through sexual health clinic software-supported workflows benefit from pre-configuring Q52.3 as a paired code template with CPT 56442 or 56700 to reduce manual code entry errors at the point of billing.

Coding guidelines and clinical nuances for Q52.3

Several coding situations require careful handling when Q52.3 is under consideration. The most common errors in this code category involve specificity failures, incorrect sequencing, and misapplication to acquired conditions.

Pediatric vs. adolescent presentation

Imperforate hymen may present differently depending on patient age. In neonates, clinicians may identify it on newborn physical examination as a bulging perineal membrane. In adolescents, it typically presents as primary amenorrhea with cyclic pelvic pain at menarche. Hematocolpos on imaging is a common finding.

In both cases, Q52.3 is the appropriate code. There is no separate code for pediatric versus adolescent presentation. What changes is the set of co-occurring codes: a neonatal encounter may carry a birth episode code from Z38.x as the principal diagnosis, while an adolescent outpatient evaluation may use Q52.3 as the principal diagnosis with secondary codes for amenorrhea (N91.0) or pelvic pain (R10.2) if documented as part of the presenting complaint. Use digital intake forms in your clinic software to capture this detail at first encounter and reduce coding queries later.

Sequencing rules: principal vs. secondary diagnosis

For outpatient encounters specifically to evaluate or treat imperforate hymen, coders assign Q52.3 as the principal diagnosis. Inpatient admissions where the patient is admitted primarily for hematocolpos management or urgent surgical correction may appropriately use the complication code (such as hematocolpos) as the principal diagnosis, with Q52.3 as an additional code identifying the underlying congenital cause.

ICD-10-CM Official Guidelines Section II governs this distinction. Outpatient coders follow UHDDS definitions on the professional fee side. Inpatient coders follow facility coding guidelines. When the record is unclear, confirm sequencing with the attending physician. The AAPC Codify ICD-10-CM lookup includes chapter-specific guidelines that coders can reference alongside the CMS tabular instructions.

Differential diagnosis coding considerations

Imperforate hymen is clinically distinguished from transverse vaginal septum (which occurs higher in the vaginal canal and codes to Q52.4 or Q52.1x), from labial fusion (Q52.5), and from Müllerian agenesis (Q52.0). Documentation that clearly pinpoints the obstruction to the hymen supports Q52.3 over the less specific Q52.4. When imaging or surgical findings are not yet available and the record documents only “suspected vaginal obstruction,” outpatient coding guidelines restrict coders to using the confirmed documented diagnosis; do not use Q52.3 until the physician confirms the hymenal location.

Clinics using claims management software with ICD-10 validation rules can flag Q52.3 claims submitted for male patients. The code is female-only. Validation rules also catch sequencing errors before submission to the payer.

Coding teams tracking compliance across multiple providers or locations will find that ICD-10 congenital malformation coding shares many of the same documentation-first principles: the code follows the confirmed diagnosis, specificity is preferred over the unspecified fallback, and the physician record must support every code assigned.

Practices that need to maintain audit-ready records across multiple diagnosis types benefit from compliance management tools that link coding policies to patient encounter documentation, reducing the gap between clinical notes and submitted codes.

Conclusion

Imperforate hymen is a specific, billable congenital condition with a clear ICD-10 code. When documentation confirms hymenal obstruction of congenital origin, Q52.3 is the correct and only appropriate code; defaulting to the unspecified Q52.4 introduces audit risk and payer friction that accurate coding avoids entirely.

Pabau’s patient record documentation and claims workflows help OB-GYN and women’s health practices capture diagnosis codes accurately from the point of clinical encounter through payer submission, reducing manual coding errors for congenital condition billing. To see how Pabau handles diagnostic coding workflows for your specialty, book a demo with our team.

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