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ICD-10 Guide
ICD-10 CodesN95.9

N95.9

Billable

Unspecified menopausal and perimenopausal disorder

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

Code Description

ICD-10 N95.9 is a billable code used to indicate a diagnosis of unspecified menopausal and perimenopausal disorder.

Key Diagnostic Point:

N95.9 refers to unspecified menopausal and perimenopausal disorders, which encompass a range of symptoms and conditions that occur during the transition to menopause, known as perimenopause, and the post-menopausal phase. This code is used when the specific nature of the menopausal disorder is not clearly defined. Common symptoms include hot flashes, night sweats, mood changes, and irregular menstrual cycles. These symptoms can significantly impact a woman's quality of life and may be associated with other health issues such as osteoporosis and cardiovascular disease. The diagnosis is typically made based on clinical history and symptomatology, as laboratory tests may not always provide definitive results. It is crucial for healthcare providers to assess the patient's overall health, including any menstrual disorders, reproductive health concerns, and potential infertility issues, as these can be interrelated during the menopausal transition. Proper documentation is essential to capture the complexity of the patient's condition and to support the use of this code.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptoms and severity among patients
  • Overlap with other reproductive health conditions
  • Need for comprehensive patient history and symptom tracking
  • Potential for co-existing conditions affecting diagnosis

Audit Risk Factors

  • Insufficient documentation of symptoms
  • Failure to differentiate from other reproductive disorders
  • Inadequate patient history regarding menstrual cycles
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Gynecology

Documentation Requirements

Detailed patient history, symptom tracking, and treatment plans.

Common Clinical Scenarios

Patients presenting with hot flashes, mood swings, and irregular periods.

Billing Considerations

Consideration of hormone replacement therapy and its implications.

Endocrinology

Documentation Requirements

Thorough evaluation of hormonal levels and metabolic health.

Common Clinical Scenarios

Patients with hormonal imbalances affecting menopausal symptoms.

Billing Considerations

Assessment of thyroid function and other endocrine disorders.

Coding Guidelines

Inclusion Criteria

Use N95.9 When
  • According to ICD
  • 10 coding guidelines, N95
  • 9 should be used when the menopausal disorder is not specified
  • Coders should ensure that the documentation supports the diagnosis and that no other more specific codes apply
  • It is important to review the patient's history and current symptoms thoroughly

Exclusion Criteria

Do NOT use N95.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits regarding menopausal symptoms.

Documentation Requirements

Document the patient's symptoms, treatment plan, and any changes in health status.

Specialty Considerations

Gynecologists should focus on reproductive health history.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of menopausal disorders, improving the ability to capture the complexity of women's health issues. N95.9 serves as a catch-all for unspecified cases, but coders must strive for specificity when possible.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of menopausal disorders, improving the ability to capture the complexity of women's health issues. N95.9 serves as a catch-all for unspecified cases, but coders must strive for specificity when possible.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of menopausal disorders, improving the ability to capture the complexity of women's health issues. N95.9 serves as a catch-all for unspecified cases, but coders must strive for specificity when possible.

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

When should I use N95.9?

Use N95.9 when a patient presents with menopausal or perimenopausal symptoms that are not clearly defined or when specific diagnostic criteria are not met.