ICD-10 Coding for Amenorrhea(N91.0, N91.1, N91.2)
Complete ICD-10-CM coding and documentation guide for Amenorrhea. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Amenorrhea
N91.0-N91.2Primary Range
Amenorrhea
This range includes codes for primary, secondary, and unspecified amenorrhea, which are the main categories for this condition.
Ovarian dysfunction
These codes are used for conditions like PCOS and primary ovarian failure, which can be related to amenorrhea.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N91.0 | Primary amenorrhea | Use for patients who have not started menstruating by age 15 with secondary sexual characteristics or by age 13 without them. |
|
| N91.1 | Secondary amenorrhea | Use for patients with a history of regular menstruation who have missed three or more consecutive cycles. |
|
| N91.2 | Amenorrhea, unspecified | Use when documentation does not specify whether amenorrhea is primary or secondary. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for primary amenorrhea
Essential facts and insights about Amenorrhea
Primary ICD-10-CM Codes for amenorrhea
Decision Criteria
clinical Criteria
- Absence of menarche by age 15 with secondary sexual characteristics or by age 13 without them.
Applicable To
- Absence of menarche by age 15 with secondary sexual characteristics
- Absence of menarche by age 13 without secondary sexual characteristics
Excludes
- Ovarian dysfunction (E28.-)
Clinical Validation Requirements
- Patient age and absence of menarche
- Presence or absence of secondary sexual characteristics
- Pelvic ultrasound confirming uterine anatomy
Code-Specific Risks
- Misclassification if secondary sexual characteristics are not documented.
Coding Notes
- Ensure documentation includes age and secondary sexual characteristics.
N91.1 - Secondary amenorrhea
Use for patients with a history of regular menstruation who have missed three or more consecutive cycles.
Applicable To
- Absence of menstruation for ≥3 consecutive cycles in previously menstruating patients
Excludes
- Pregnancy, lactation, menopause
Clinical Validation Requirements
- History of regular menstruation followed by absence for ≥3 cycles
- Negative pregnancy test, normal prolactin and TSH levels
Coding Notes
Ensure menstrual history and exclusion of pregnancy are documented.
N91.2 - Amenorrhea, unspecified
Use when documentation does not specify whether amenorrhea is primary or secondary.
Applicable To
- Amenorrhea not otherwise specified
Excludes
- Specific types of amenorrhea (N91.0, N91.1)
Clinical Validation Requirements
- Lack of specific documentation to classify as primary or secondary
Coding Notes
Use only when specific type of amenorrhea cannot be determined.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Primary ovarian failure
E28.3Polycystic ovarian syndrome
E28.2Primary amenorrhea
N91.0Secondary amenorrhea
N91.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Amenorrhea to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N91.0.
Impact
Clinical: Misdiagnosis of amenorrhea type., Regulatory: Potential for audit and compliance issues., Financial: Incorrect coding may lead to reimbursement denials.
Mitigation Strategy
Ensure thorough physical examination documentation., Include Tanner staging in records.
Impact
Reimbursement: May affect DRG assignments and reimbursement rates., Compliance: Increases risk of audits and denials., Data Quality: Leads to inaccurate data collection and reporting.
Mitigation Strategy
Query provider for more details to specify primary or secondary amenorrhea.
Impact
High audit risk when using N91.2 without sufficient documentation.
Mitigation Strategy
Ensure detailed documentation to support specific coding.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Amenorrhea, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Amenorrhea
Use these documentation templates to ensure complete and accurate documentation for Amenorrhea. These templates include all required elements for proper coding and billing.
Amenorrhea evaluation
Specialty: GynecologyRequired Elements
- Menstrual history
- Physical exam findings
- Laboratory results
- Imaging studies
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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