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ICD-10 Guide
ICD-10 CodesN95.8

N95.8

Billable

Other specified menopausal and perimenopausal disorders

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

Code Description

ICD-10 N95.8 is a billable code used to indicate a diagnosis of other specified menopausal and perimenopausal disorders.

Key Diagnostic Point:

N95.8 encompasses a range of disorders that occur during the menopausal and perimenopausal phases of a woman's life, which typically occur between the ages of 45 and 55. These disorders can include irregular menstrual cycles, hot flashes, night sweats, mood changes, and other symptoms that may not fit neatly into other established categories. The perimenopausal phase is characterized by hormonal fluctuations that can lead to various menstrual disorders, including amenorrhea, oligomenorrhea, and dysmenorrhea. Additionally, this code may be used for conditions related to female infertility that arise during this transitional period, as well as complications from artificial fertilization procedures. Accurate coding requires a thorough understanding of the patient's symptoms, history, and any treatments they may have undergone, as these factors can significantly influence the clinical picture and the appropriate coding choice.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of symptoms that can be associated with menopause and perimenopause.
  • Overlap with other codes related to menstrual disorders and infertility.
  • Need for detailed patient history to determine the correct diagnosis.
  • Potential for misdiagnosis if symptoms are not clearly documented.

Audit Risk Factors

  • Inadequate documentation of symptoms and their duration.
  • Failure to specify the type of menopausal disorder.
  • Misalignment between diagnosis and treatment provided.
  • Inconsistent coding practices among different providers.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed patient history, including menstrual cycle patterns, symptom severity, and any treatments received.

Common Clinical Scenarios

Patients presenting with hot flashes, irregular periods, or mood changes during perimenopause.

Billing Considerations

Ensure that all symptoms are documented clearly to support the diagnosis and coding.

Reproductive Endocrinology

Documentation Requirements

Comprehensive evaluation of hormonal levels, infertility assessments, and treatment plans.

Common Clinical Scenarios

Women experiencing infertility issues related to hormonal changes during menopause.

Billing Considerations

Document any artificial fertilization procedures and their outcomes to support coding.

Coding Guidelines

Inclusion Criteria

Use N95.8 When
  • According to ICD
  • 10 guidelines, N95
  • 8 should be used when a patient presents with menopausal or perimenopausal symptoms that do not fit into other specified categories
  • Coders should ensure that the documentation supports the diagnosis and that any related conditions are also coded appropriately

Exclusion Criteria

Do NOT use N95.8 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 with menopausal symptoms for evaluation.

Documentation Requirements

Document the patient's symptoms, history, and any treatments discussed.

Specialty Considerations

Obstetricians should ensure that all relevant symptoms are documented to support the visit level.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of menopausal and perimenopausal disorders, enabling better tracking of these conditions and their management. N95.8 provides a means to capture a broader range of symptoms and disorders that may not have been adequately represented in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of menopausal and perimenopausal disorders, enabling better tracking of these conditions and their management. N95.8 provides a means to capture a broader range of symptoms and disorders that may not have been adequately represented in ICD-9.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of menopausal and perimenopausal disorders, enabling better tracking of these conditions and their management. N95.8 provides a means to capture a broader range of symptoms and disorders that may not have been adequately represented in ICD-9.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What symptoms are included under N95.8?

N95.8 includes a variety of symptoms related to menopause and perimenopause, such as hot flashes, night sweats, mood changes, and irregular menstrual cycles that do not fit into other specified categories.