ICD-10 Coding for Perimenopause(N95.1, N92.4)
Complete ICD-10-CM coding and documentation guide for Perimenopause. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to 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 female climacteric states | Use for symptomatic perimenopause with documented vasomotor symptoms or irregular cycles. |
|
| N92.4 | Excessive bleeding in premenopausal period | Use for excessive bleeding during perimenopause. |
|
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 perimenopause
Essential facts and insights about Perimenopause
Primary ICD-10-CM Codes for perimenopause
Decision Criteria
clinical Criteria
- Presence of vasomotor symptoms and elevated FSH levels.
Applicable To
- Vasomotor symptoms
- Irregular cycles
Excludes
- Postmenopausal bleeding (N95.0)
Clinical Validation Requirements
- FSH >25 mIU/mL
- Estradiol <30 pg/mL
- Documented vasomotor symptoms
Code-Specific Risks
- Confusion with postmenopausal codes
Coding Notes
- Ensure documentation supports the presence of symptoms.
N92.4 - Excessive bleeding in premenopausal period
Use for excessive bleeding during perimenopause.
Applicable To
- Irregular heavy bleeding
Excludes
- Postmenopausal bleeding (N95.0)
Clinical Validation Requirements
- Menstrual history confirming excessive bleeding
Coding Notes
Document menstrual patterns and bleeding quantification.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other ovarian dysfunction
E28.8Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Postmenopausal bleeding
N95.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Perimenopause to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N95.1.
Impact
Clinical: Misdiagnosis risk, Regulatory: Non-compliance with coding standards, Financial: Potential reimbursement issues
Mitigation Strategy
Ensure detailed symptom documentation, Verify lab results
Impact
Reimbursement: Incorrect DRG assignment, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate patient records
Mitigation Strategy
Use N92.4 for bleeding before 12 months of amenorrhea.
Impact
Inadequate documentation of symptoms can lead to audit issues.
Mitigation Strategy
Ensure comprehensive documentation of all symptoms and lab results.
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 Perimenopause, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Perimenopause
Use these documentation templates to ensure complete and accurate documentation for Perimenopause. These templates include all required elements for proper coding and billing.
Perimenopausal symptoms management
Specialty: GynecologyRequired Elements
- Symptom duration
- FSH levels
- Menstrual history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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