ICD-10 Coding for Perimenopausal(N95.1, N92.4)
Complete ICD-10-CM coding and documentation guide for Perimenopausal. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Perimenopausal
N95.0-N95.9Primary Range
Menopausal and other perimenopausal disorders
This range includes codes specific to menopausal and perimenopausal states, covering symptoms and conditions associated with the transition.
Excessive, frequent and irregular menstruation
This range includes codes for menstrual irregularities that may occur during perimenopause.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N95.1 | Menopausal and other perimenopausal disorders | Use for patients experiencing perimenopausal symptoms such as hot flashes and irregular cycles. |
|
| N92.4 | Excessive bleeding in premenopausal women | Use when excessive bleeding occurs in women with regular cycles. |
|
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 perimenopausal symptoms
Essential facts and insights about Perimenopausal
Primary ICD-10-CM Codes for perimenopausal
Decision Criteria
clinical Criteria
- Patient is between 40-55 years with irregular cycles and vasomotor symptoms.
coding Criteria
- Do not use for postmenopausal bleeding.
Applicable To
- Vasomotor symptoms
- Irregular cycles
- Mood changes
Excludes
- N92.4 - Excessive bleeding in premenopausal women
Clinical Validation Requirements
- Age 40-55
- FSH >25 mIU/mL
- Symptoms like hot flashes, night sweats
Code-Specific Risks
- Misuse for postmenopausal symptoms
- Lack of symptom documentation
Coding Notes
- Ensure documentation clearly links symptoms to perimenopausal transition.
N92.4 - Excessive bleeding in premenopausal women
Use when excessive bleeding occurs in women with regular cycles.
Applicable To
- Menometrorrhagia
Excludes
- N95.1 - Perimenopausal symptoms
Clinical Validation Requirements
- Documented excessive bleeding
- Regular cycles
Coding Notes
Ensure bleeding is not part of the perimenopausal transition.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Depression, unspecified
F32.9Differential 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 Perimenopausal to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N95.1.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Potential for audit failure., Financial: Reduced reimbursement due to incorrect coding.
Mitigation Strategy
Use specific symptom descriptions., Link symptoms to perimenopausal transition.
Impact
Reimbursement: Incorrect DRG assignment may reduce reimbursement., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use N95.1 for perimenopausal symptoms with irregular cycles.
Impact
Inadequate documentation of perimenopausal symptoms.
Mitigation Strategy
Ensure detailed and specific symptom 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 Perimenopausal, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Perimenopausal
Use these documentation templates to ensure complete and accurate documentation for Perimenopausal. These templates include all required elements for proper coding and billing.
Perimenopausal symptoms with mood changes
Specialty: GynecologyRequired Elements
- Patient age
- Menstrual history
- Symptom description
- FSH levels
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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