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ICD-10 Guide
ICD-10 CodesChapter 14: Diseases of the genitourinary systemN97

N97

Billable

Female infertility

Chapter 14:Diseases of the genitourinary system

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

Code Description

ICD-10 N97 is a billable code used to indicate a diagnosis of female infertility.

Key Diagnostic Point:

Female infertility is defined as the inability of a woman to conceive after one year of unprotected intercourse. This condition can arise from various factors affecting the reproductive system, including hormonal imbalances, anatomical abnormalities, and underlying medical conditions. Menstrual disorders, such as irregular cycles or amenorrhea, can significantly impact fertility by disrupting ovulation. Additionally, menopausal disorders, which may lead to premature ovarian failure, can also contribute to infertility. Complications from artificial fertilization techniques, such as in vitro fertilization (IVF), may further complicate the diagnosis and management of infertility. Accurate diagnosis often requires a comprehensive evaluation, including hormonal assessments, imaging studies, and possibly laparoscopy to identify any anatomical issues. Understanding the multifactorial nature of female infertility is crucial for effective treatment and management, which may include lifestyle modifications, medical therapies, or assisted reproductive technologies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes (hormonal, anatomical, etc.)
  • Need for comprehensive diagnostic testing
  • Potential for multiple co-existing conditions
  • Variability in treatment approaches

Audit Risk Factors

  • Inadequate documentation of infertility workup
  • Failure to specify the type of infertility (primary vs. secondary)
  • Lack of clarity on associated menstrual or menopausal disorders
  • Improper coding of related procedures or treatments

Specialty Focus

Medical Specialties

Reproductive Endocrinology

Documentation Requirements

Detailed history of menstrual cycles, hormonal evaluations, and previous fertility treatments.

Common Clinical Scenarios

Patients presenting with irregular cycles, history of miscarriage, or previous unsuccessful fertility treatments.

Billing Considerations

Ensure all diagnostic tests and treatments are documented to support the infertility diagnosis.

Obstetrics and Gynecology

Documentation Requirements

Comprehensive documentation of gynecological history, physical exams, and any relevant imaging studies.

Common Clinical Scenarios

Women seeking evaluation for infertility after one year of trying to conceive.

Billing Considerations

Document any referrals to specialists and the rationale for treatment decisions.

Coding Guidelines

Inclusion Criteria

Use N97 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the patient's infertility status, including duration and type (primary or secondary)
  • Include any relevant menstrual or menopausal disorders that may contribute to the infertility diagnosis

Exclusion Criteria

Do NOT use N97 When
No specific exclusions found.

Related CPT Codes

58321CPT Code

Laparoscopy, surgical, with or without biopsy

Clinical Scenario

Used for diagnostic evaluation of infertility when anatomical issues are suspected.

Documentation Requirements

Document indications for the procedure and findings.

Specialty Considerations

Ensure alignment with infertility diagnosis and any associated conditions.

58970CPT Code

In vitro fertilization (IVF)

Clinical Scenario

Used when assisted reproductive technology is indicated.

Documentation Requirements

Document the patient's infertility diagnosis and treatment plan.

Specialty Considerations

Include details of previous treatments and outcomes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of female infertility, enabling better tracking of treatment outcomes and more precise reimbursement for services rendered.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of female infertility, enabling better tracking of treatment outcomes and more precise reimbursement for services rendered.

Reimbursement & Billing Impact

reimbursement for services rendered.

Resources

Clinical References

  • •
    American Society for Reproductive Medicine
  • •
    Centers for Disease Control and Prevention - Infertility

Coding & Billing References

  • •
    American Society for Reproductive Medicine
  • •
    Centers for Disease Control and Prevention - Infertility

Frequently Asked Questions

What is the difference between primary and secondary infertility?

Primary infertility refers to the inability to conceive after one year of unprotected intercourse in women who have never been pregnant, while secondary infertility refers to the inability to conceive after one year of unprotected intercourse in women who have previously been pregnant.

What documentation is needed to support a diagnosis of female infertility?

Documentation should include a detailed medical history, menstrual cycle patterns, results of any hormonal tests, imaging studies, and records of previous fertility treatments.