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ICD-10 Coding for Menstrual Cramp(N94.4, N94.5, N94.89)

Complete ICD-10-CM coding and documentation guide for Menstrual Cramp. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

DysmenorrheaMenstrual Pain

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Related ICD-10 Code Ranges

Complete code families applicable to Menstrual Cramp

N94.4-N94.5Primary Range

Dysmenorrhea, primary and secondary

These codes cover primary and secondary dysmenorrhea, which are the main categories for menstrual cramps.

N94.89

Other specified conditions associated with female genital organs and menstrual cycle

Used for atypical symptoms not covered by primary dysmenorrhea codes.

R10.2

Pelvic and perineal pain

Used as an ancillary code to specify pain location.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
N94.4Primary dysmenorrheaUse when no identifiable pelvic pathology is present and symptoms began shortly after menarche.
  • Normal pelvic exam
  • Cyclical pain beginning within 1-2 years of menarche
N94.5Secondary dysmenorrheaUse when cramps are associated with a confirmed underlying condition.
  • Imaging showing fibroids or endometriosis
  • Biopsy confirming adenomyosis
N94.89Other specified conditions associated with female genital organs and menstrual cycleUse when symptoms do not meet criteria for N94.4 or N94.5.
  • Non-cyclical pelvic pain
  • Atypical cramping pattern

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 menstrual cramps

Essential facts and insights about Menstrual Cramp

The ICD-10 code for primary dysmenorrhea is N94.4, and for secondary dysmenorrhea, it is N94.5. Use these codes based on the presence of an underlying condition.

Primary ICD-10-CM Codes for menstrual cramp

N94.4
Primary dysmenorrhea
Billable Code

Decision Criteria

clinical Criteria

  • No identifiable pelvic pathology

documentation Criteria

  • Cyclical pain beginning within 1-2 years of menarche

Applicable To

  • Recurrent cramping without identifiable pathology

Excludes

  • Secondary dysmenorrhea (N94.5)

Clinical Validation Requirements

  • Normal pelvic exam
  • Cyclical pain beginning within 1-2 years of menarche

Code-Specific Risks

  • Misclassification if underlying pathology is present

Coding Notes

  • Ensure documentation specifies absence of identifiable pathology.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Pelvic and perineal pain

R10.2
Use to specify pain location if documented.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Secondary dysmenorrhea

N94.5
Presence of an underlying condition such as endometriosis or fibroids.

Primary dysmenorrhea

N94.4
No underlying condition present.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Menstrual Cramp to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N94.4.

Impact

Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.

Mitigation Strategy

Use specific descriptors for pain, Link symptoms to diagnostic findings

Impact

Reimbursement: Claims may be denied due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Reduces accuracy of health data.

Mitigation Strategy

Use specific codes like N94.4 or N94.5 once etiology is known.

Impact

Reimbursement: Incorrect coding can lead to claim rejections., Compliance: Fails to meet documentation standards., Data Quality: Impacts clinical data integrity.

Mitigation Strategy

Document and code the underlying cause when known.

Impact

High risk of audit if unspecified codes are used after diagnosis.

Mitigation Strategy

Ensure specific codes are used once the cause of dysmenorrhea is identified.

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 Menstrual Cramp, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Menstrual Cramp

Use these documentation templates to ensure complete and accurate documentation for Menstrual Cramp. These templates include all required elements for proper coding and billing.

Menstrual cramps with no identifiable pathology

Specialty: Gynecology

Required Elements

  • Onset and duration of pain
  • Response to treatment
  • Imaging results

Example Documentation

Patient reports throbbing lower abdominal pain starting 2 days pre-menses, unresponsive to NSAIDs. Pelvic ultrasound normal. Diagnosis: Primary dysmenorrhea (N94.4).

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has period pain.
Good Documentation Example
Patient reports throbbing lower abdominal pain starting 2 days pre-menses, unresponsive to NSAIDs, with no evidence of endometriosis on ultrasound.
Explanation
The good example provides specific details about the pain and confirms the absence of underlying pathology.

Need help with ICD-10 coding for Menstrual Cramp? Ask your questions below.

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