ICD-10 Coding for Menstrual Cramping(N94.4, N94.5, N94.6)
Complete ICD-10-CM coding and documentation guide for Menstrual Cramping. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Menstrual Cramping
N94.4-N94.6Primary Range
Pain and other conditions associated with female genital organs and menstrual cycle
This range includes codes for primary, secondary, and unspecified dysmenorrhea.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N94.4 | Primary dysmenorrhea | Use when menstrual pain occurs without any identifiable pelvic pathology. |
|
| N94.5 | Secondary dysmenorrhea | Use when menstrual pain is due to an identifiable underlying condition. |
|
| N94.6 | Dysmenorrhea, unspecified | Use when the cause of menstrual pain is unclear and further evaluation is pending. |
|
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 cramping
Essential facts and insights about Menstrual Cramping
Primary ICD-10-CM Codes for menstrual cramping
Decision Criteria
clinical Criteria
- No identifiable pelvic pathology
Applicable To
- Menstrual pain without underlying pathology
Excludes
- Secondary dysmenorrhea (N94.5)
Clinical Validation Requirements
- Negative pelvic imaging within 2 years
- Normal pelvic exam
- Age <25
Code-Specific Risks
- Using without imaging in patients >30yo
Coding Notes
- Ensure documentation specifies absence of underlying conditions.
N94.5 - Secondary dysmenorrhea
Use when menstrual pain is due to an identifiable underlying condition.
Applicable To
- Menstrual pain due to underlying conditions like endometriosis
Excludes
- Primary dysmenorrhea (N94.4)
Clinical Validation Requirements
- Laparoscopy/pathology reports
- Characteristic MRI findings
- CA-125 >35
Coding Notes
Always sequence the underlying condition first.
N94.6 - Dysmenorrhea, unspecified
Use when the cause of menstrual pain is unclear and further evaluation is pending.
Applicable To
- Menstrual pain with insufficient workup
Clinical Validation Requirements
- Documentation of deferred workup
- Patient refusal statement signed
Coding Notes
Use only when cause isn't identified, and ensure that the lack of cause is clear in the notes.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Menstrual Cramping to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N94.4.
Impact
Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Thorough patient history, Comprehensive diagnostic workup
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on patient conditions.
Mitigation Strategy
Use N94.5 with appropriate documentation of the underlying condition.
Impact
Frequent use of unspecified codes without justification can trigger audits.
Mitigation Strategy
Ensure documentation supports the use of unspecified codes and pursue further diagnostics.
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 Cramping, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Menstrual Cramping
Use these documentation templates to ensure complete and accurate documentation for Menstrual Cramping. These templates include all required elements for proper coding and billing.
Menstrual cramping evaluation
Specialty: GynecologyRequired Elements
- Menstrual history
- Pain characteristics
- Pelvic imaging results
- Differential diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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