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ICD-10 Guide
ICD-10 CodesE28.3

E28.3

Billable

Primary ovarian failure

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 E28.3 is a billable code used to indicate a diagnosis of primary ovarian failure.

Key Diagnostic Point:

Primary ovarian failure, also known as primary ovarian insufficiency (POI), is a condition characterized by the loss of normal ovarian function before the age of 40. This condition can lead to irregular or absent menstrual periods, infertility, and symptoms associated with estrogen deficiency, such as hot flashes, night sweats, and vaginal dryness. The etiology of primary ovarian failure can be multifactorial, including genetic factors, autoimmune disorders, and environmental influences. Hormonal imbalances are common, particularly involving estrogen and progesterone, which can lead to secondary effects on the pituitary and adrenal glands. The pituitary gland may respond to low estrogen levels by increasing the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which can be elevated in patients with POI. Additionally, conditions such as Turner syndrome, Fragile X syndrome, and autoimmune diseases like Addison's disease can contribute to the development of primary ovarian failure. Diagnosis typically involves a combination of clinical evaluation, hormonal assays, and imaging studies to assess ovarian structure and function. Understanding the underlying causes is crucial for management and treatment, which may include hormone replacement therapy and fertility options.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes (genetic, autoimmune, environmental)
  • Need for comprehensive hormonal evaluation
  • Potential overlap with other endocrine disorders
  • Variability in clinical presentation and symptoms

Audit Risk Factors

  • Inadequate documentation of hormonal assays
  • Failure to document associated conditions
  • Misclassification of primary vs. secondary ovarian failure
  • Lack of clear clinical correlation with symptoms

Specialty Focus

Medical Specialties

Reproductive Endocrinology

Documentation Requirements

Detailed hormonal profiles, menstrual history, and fertility assessments.

Common Clinical Scenarios

Evaluation of infertility in women under 40, management of menopausal symptoms in young women.

Billing Considerations

Ensure documentation reflects the complexity of hormonal imbalances and associated conditions.

Endocrinology

Documentation Requirements

Comprehensive endocrine evaluations, including thyroid and adrenal function tests.

Common Clinical Scenarios

Assessment of patients with suspected endocrine disorders contributing to ovarian failure.

Billing Considerations

Document any coexisting endocrine disorders that may complicate the clinical picture.

Coding Guidelines

Inclusion Criteria

Use E28.3 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the diagnosis, associated symptoms, and any underlying conditions
  • Include relevant laboratory results and clinical findings to support the diagnosis

Exclusion Criteria

Do NOT use E28.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

83001CPT Code

FSH test

Clinical Scenario

Used to confirm diagnosis of primary ovarian failure.

Documentation Requirements

Document the reason for testing and results.

Specialty Considerations

Endocrinologists should ensure comprehensive hormonal panels are included.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of primary ovarian failure, improving the accuracy of diagnosis and treatment tracking. This specificity aids in better understanding the epidemiology and management of the condition.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of primary ovarian failure, improving the accuracy of diagnosis and treatment tracking. This specificity aids in better understanding the epidemiology and management of the condition.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of primary ovarian failure, improving the accuracy of diagnosis and treatment tracking. This specificity aids in better understanding the epidemiology and management of the condition.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What are the common symptoms of primary ovarian failure?

Common symptoms include irregular or absent menstrual periods, hot flashes, night sweats, vaginal dryness, and infertility.

How is primary ovarian failure diagnosed?

Diagnosis typically involves hormonal assays showing elevated FSH and low estrogen levels, along with clinical evaluation of symptoms.

Can primary ovarian failure be treated?

Treatment options may include hormone replacement therapy to manage symptoms and fertility treatments for those seeking to conceive.