ICD-10 Coding for Fertility Issues(N97.0, N46.1, Z31.83)
Complete ICD-10-CM coding and documentation guide for Fertility Issues. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fertility Issues
N97Primary Range
Female infertility
This range covers various types of female infertility, including anovulation and tubal factor infertility.
Male infertility
This range addresses male infertility issues such as oligospermia and azoospermia.
Encounter for procreative management
This range includes codes for fertility testing and assisted reproductive technology procedures.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N97.0 | Female infertility associated with anovulation | Use when infertility is due to lack of ovulation, confirmed by hormonal tests and cycle tracking. |
|
| N46.1 | Oligospermia | Use when semen analysis confirms low sperm count as a factor in infertility. |
|
| Z31.83 | Encounter for assisted reproductive fertility procedure cycle | Use for encounters related to ART cycles, such as IVF. |
|
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 female infertility
Essential facts and insights about Fertility Issues
Primary ICD-10-CM Codes for fertility
Decision Criteria
clinical Criteria
- Documented anovulation with supporting lab results.
Applicable To
- Anovulatory infertility
Excludes
- Polycystic ovarian syndrome (E28.2)
Clinical Validation Requirements
- FSH >10 mIU/mL
- Anovulatory cycles on BBT charting
Code-Specific Risks
- Misclassification if ovulation is not properly documented.
Coding Notes
- Ensure hormonal tests confirm anovulation before coding.
N46.1 - Oligospermia
Use when semen analysis confirms low sperm count as a factor in infertility.
Applicable To
- Low sperm count
Excludes
- Azoospermia (N46.0)
Clinical Validation Requirements
- Semen analysis showing <15 million sperm/mL
Coding Notes
Link to female infertility codes if applicable.
Z31.83 - Encounter for assisted reproductive fertility procedure cycle
Use for encounters related to ART cycles, such as IVF.
Applicable To
- IVF cycle
Clinical Validation Requirements
- Documented ART procedure initiation
Coding Notes
Document all ART-related procedures and outcomes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Polycystic ovarian syndrome
E28.2Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fertility Issues to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N97.0.
Impact
Clinical: Incomplete clinical picture affecting treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to incomplete coding.
Mitigation Strategy
Always include male factor analysis in infertility workup., Use structured templates for documentation.
Impact
Reimbursement: May lead to denied claims due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Identify and document specific infertility factors before coding.
Impact
Inadequate documentation of ART cycles can lead to audit issues.
Mitigation Strategy
Use detailed templates and ensure all procedures are documented.
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 Fertility Issues, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fertility Issues
Use these documentation templates to ensure complete and accurate documentation for Fertility Issues. These templates include all required elements for proper coding and billing.
Infertility Workup
Specialty: Reproductive EndocrinologyRequired Elements
- Duration of infertility
- Female and male workup results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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