ICD-10 Coding for Menstrual Pain(N94.4, N94.5, R10.2)
Complete ICD-10-CM coding and documentation guide for Menstrual Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Menstrual Pain
N94.4-N94.5Primary Range
Dysmenorrhea, primary and secondary
This range covers primary and secondary dysmenorrhea, which are the main conditions associated with menstrual pain.
Pelvic and perineal pain
This code is used for pelvic pain not specifically linked to the menstrual cycle.
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 underlying condition. |
|
| N94.5 | Secondary dysmenorrhea | Use when menstrual pain is due to an underlying condition. |
|
| R10.2 | Pelvic and perineal pain | Use for pelvic pain not related to the menstrual cycle. |
|
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 dysmenorrhea
Essential facts and insights about Menstrual Pain
Primary ICD-10-CM Codes for menstrual pain
Decision Criteria
clinical Criteria
- Pain is cyclic and no organic cause is identified.
Applicable To
- Cyclic pain without underlying pathology
Excludes
- Secondary dysmenorrhea (N94.5)
Clinical Validation Requirements
- Normal pelvic exam
- No structural abnormalities on imaging
Code-Specific Risks
- Incorrectly coding when an underlying condition is present
Coding Notes
- Ensure no underlying condition is present before using this code.
N94.5 - Secondary dysmenorrhea
Use when menstrual pain is due to an underlying condition.
Applicable To
- Pain with confirmed etiology
Excludes
- Primary dysmenorrhea (N94.4)
Clinical Validation Requirements
- Biopsy or laparoscopy reports confirming endometriosis, fibroids, or PID
Coding Notes
Always document and code the underlying condition first.
R10.2 - Pelvic and perineal pain
Use for pelvic pain not related to the menstrual cycle.
Applicable To
- Non-cyclic pelvic pain
Excludes
- Pain related to menstrual cycle (N94.4, N94.5)
Clinical Validation Requirements
- Pain diaries showing non-cyclic pattern
Coding Notes
Ensure pain is not linked to menstrual cycle before using.
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 Menstrual Pain 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 diagnosis and treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always confirm and document the presence or absence of underlying conditions., Use specific codes based on clinical findings.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding specificity requirements., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Use N94.4 or N94.5 based on the presence of an underlying condition.
Impact
Risk of audits due to use of unspecified codes.
Mitigation Strategy
Use specific codes and document underlying conditions clearly.
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 Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Menstrual Pain
Use these documentation templates to ensure complete and accurate documentation for Menstrual Pain. These templates include all required elements for proper coding and billing.
Patient with primary dysmenorrhea
Specialty: OB/GYNRequired Elements
- Menstrual history
- Pain characteristics
- Imaging results
- Exclusion of underlying conditions
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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