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v1.0.0
ICD-10 Guide
ICD-10 CodesN94.4

N94.4

Billable

Primary dysmenorrhea

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/18/2025

Code Description

ICD-10 N94.4 is a billable code used to indicate a diagnosis of primary dysmenorrhea.

Key Diagnostic Point:

Primary dysmenorrhea is a common menstrual disorder characterized by recurrent abdominal pain associated with menstruation. It typically begins shortly before or at the onset of menstruation and can last for several days. The pain is often described as cramping and may be accompanied by other symptoms such as nausea, vomiting, diarrhea, and headaches. Primary dysmenorrhea is thought to be caused by the release of prostaglandins, which are hormone-like substances that trigger uterine contractions. This condition is most prevalent in adolescents and young women, often improving with age or after childbirth. Diagnosis is primarily clinical, based on the patient's history and symptomatology, and it is essential to rule out secondary causes of dysmenorrhea, such as endometriosis or fibroids. Treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), hormonal contraceptives, and lifestyle modifications. Understanding primary dysmenorrhea is crucial for reproductive health, as it can significantly impact a woman's quality of life and may be associated with other menstrual disorders.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from secondary dysmenorrhea
  • Variability in symptom presentation
  • Need for comprehensive patient history
  • Potential overlap with other menstrual disorders

Audit Risk Factors

  • Inadequate documentation of symptoms
  • Failure to differentiate from secondary dysmenorrhea
  • Lack of treatment documentation
  • Misuse of related codes

Specialty Focus

Medical Specialties

Gynecology

Documentation Requirements

Detailed patient history, symptom description, treatment plans, and follow-up notes.

Common Clinical Scenarios

Patients presenting with severe menstrual cramps, seeking relief options, or reporting associated symptoms like nausea.

Billing Considerations

Ensure to document any secondary causes ruled out and the patient's response to treatment.

Family Medicine

Documentation Requirements

Comprehensive history, physical examination findings, and management strategies.

Common Clinical Scenarios

Young women presenting with menstrual pain, discussing contraceptive options for symptom management.

Billing Considerations

Consider the patient's overall reproductive health and any related menstrual disorders.

Coding Guidelines

Inclusion Criteria

Use N94.4 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the patient's symptoms and ruling out secondary causes
  • Include relevant history and treatment plans in the medical record

Exclusion Criteria

Do NOT use N94.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used when a patient presents for management of primary dysmenorrhea.

Documentation Requirements

Document the patient's history, examination findings, and treatment plan.

Specialty Considerations

Ensure to include any relevant gynecological history.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of menstrual disorders, improving the ability to capture the nuances of conditions like primary dysmenorrhea, which can lead to better patient management and research opportunities.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of menstrual disorders, improving the ability to capture the nuances of conditions like primary dysmenorrhea, which can lead to better patient management and research opportunities.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of menstrual disorders, improving the ability to capture the nuances of conditions like primary dysmenorrhea, which can lead to better patient management and research opportunities.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What is the difference between primary and secondary dysmenorrhea?

Primary dysmenorrhea is menstrual pain not associated with any identifiable pelvic pathology, while secondary dysmenorrhea is caused by underlying conditions such as endometriosis or fibroids.