ICD-10 Coding for Infertility(N97.0, N97.1, N46.1)
Complete ICD-10-CM coding and documentation guide for Infertility. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Infertility
N97Primary Range
Female infertility
This range covers various causes of female infertility, including anovulation and tubal factors.
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 procedures like IVF.
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 anovulation is confirmed by hormonal assays. |
|
| N97.1 | Female infertility of tubal origin | Use when tubal occlusion is confirmed by imaging. |
|
| N46.1 | Oligospermia | Use when semen analysis confirms low sperm count. |
|
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 infertility
Essential facts and insights about Infertility
Primary ICD-10-CM Codes for infertility
Decision Criteria
clinical Criteria
- Anovulation confirmed by lab tests.
Applicable To
- Anovulatory infertility
Excludes
- Infertility due to male factors (N46.-)
Clinical Validation Requirements
- Day 21 progesterone <3 ng/mL
- FSH/LH ratio >2
Code-Specific Risks
- Misclassification if anovulation is not confirmed.
Coding Notes
- Ensure hormonal assays confirm anovulation before coding.
N97.1 - Female infertility of tubal origin
Use when tubal occlusion is confirmed by imaging.
Applicable To
- Tubal occlusion
Excludes
- Infertility due to male factors (N46.-)
Clinical Validation Requirements
- HSG showing bilateral tubal blockage
- Laparoscopy confirming tubal occlusion
Coding Notes
Document imaging results clearly to support this code.
N46.1 - Oligospermia
Use when semen analysis confirms low sperm count.
Applicable To
- Low sperm count
Excludes
- Male infertility due to azoospermia (N46.0)
Clinical Validation Requirements
- Semen analysis showing <15 million sperm/mL
Coding Notes
Repeat semen analysis to confirm oligospermia.
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.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Infertility to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N97.0.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Always include duration in months., Verify with patient history.
Impact
Reimbursement: May lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Reduces specificity of data.
Mitigation Strategy
Use Z31.41 for testing until 12 months of infertility is documented.
Impact
High risk of audit if unspecified codes are overused.
Mitigation Strategy
Use specific codes supported by documentation.
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 Infertility, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Infertility
Use these documentation templates to ensure complete and accurate documentation for Infertility. These templates include all required elements for proper coding and billing.
Initial infertility evaluation
Specialty: Reproductive EndocrinologyRequired Elements
- Duration of infertility
- Menstrual history
- Previous fertility tests
- Partner's fertility status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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