ICD-10 Guide

Abnormal Menses

ICD-10 Coding for Abnormal Menses(N92.6, N92.5)

PRIMARY SPECIALTYGynecology

COMPLEXITYHigh

LAST UPDATED09/15/2025

Sam Tuffun, PT, DPT

Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Abnormal Menses?

Abnormal menses refers to any deviation from the normal menstrual cycle, which can include irregular, heavy, or prolonged bleeding. Key clinical points include: 1) Abnormal menses can result from hormonal imbalances, structural abnormalities, or systemic conditions. 2) Common presentations include oligomenorrhea (infrequent periods), menorrhagia (heavy bleeding), and dysmenorrhea (painful periods). 3) It is essential to differentiate between primary and secondary causes of abnormal menses to guide treatment. Typical use cases for this diagnosis code include patients presenting with menstrual irregularities, often requiring further evaluation through history, physical examination, and possibly imaging or laboratory tests. Etiologically, abnormal menses can stem from conditions such as polycystic ovary syndrome (PCOS), uterine fibroids, or thyroid disorders. Clinically, patients may report changes in cycle length, volume of bleeding, or associated symptoms such as pelvic pain or fatigue.

Key Clinical Considerations:

Diagnosis of abnormal menses requires a thorough menstrual history, including cycle regularity, duration, and volume of bleeding.
Signs and symptoms may include changes in menstrual cycle frequency, heavy menstrual bleeding, or intermenstrual bleeding.
Resolution criteria may involve normalization of menstrual cycles following treatment or lifestyle changes.
Laboratory findings may include hormonal assays, complete blood count (CBC) for anemia, and imaging studies like ultrasound to assess structural abnormalities.

Clinical Information

Clinical Criteria & Documentation Requirements

Essential documentation includes detailed menstrual history, physical examination findings, and any relevant laboratory or imaging results.
Compliant documentation examples include clear descriptions of menstrual patterns and associated symptoms, while non-compliant documentation may lack specificity.
Documentation template phrases can include: 'Patient reports irregular menstrual cycles with heavy bleeding.'
Medical necessity documentation should justify the need for diagnostic tests or treatments based on clinical findings.

Coding Guidelines

Usage Guidelines & Examples

Use this code when a patient presents with irregular menstrual cycles, such as a 35-year-old female with menorrhagia.
Do not use this code for normal menstrual variations or when the bleeding is due to a known pregnancy.
Correct usage example: 'Patient diagnosed with menorrhagia, N92.6.' Incorrect usage: 'Patient with normal menstrual cycle, N92.6.'
Common coding errors include misclassifying normal variations as abnormal; ensure thorough documentation to avoid this.

Code Exclusions

Important Exclusions

Excluded conditions include pregnancy-related bleeding (O20) and postmenopausal bleeding (N95), as these require different management.
Alternative codes for excluded conditions include O20.9 for unspecified early pregnancy bleeding.
Common exclusion errors may occur when coding for abnormal bleeding without confirming pregnancy status; always verify.
Certain conditions are excluded to ensure accurate diagnosis and appropriate treatment pathways.

Specialty Focus

Primary Specialty

Gynecology

Specialty Applications

This diagnosis applies to conditions such as menorrhagia, oligomenorrhea, and amenorrhea.
Appropriate clinical scenarios include patients presenting with complaints of heavy or irregular menstrual bleeding.
Applicable in both outpatient and inpatient settings, particularly in gynecological practices.
Specialty-specific considerations include the need for gynecological evaluation and potential referral for further management.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

Comprehensive clinical documentation
Accurate code selection based on clinical criteria
Proper exclusion considerations
Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Abnormal menses diagnosed based on irregular cycle patterns and heavy bleeding.'

Template 2

Template: 'Patient presents with menorrhagia consistent with N92.6 diagnosis.'

Template 3

Template: 'Diagnostic criteria met: excessive menstrual bleeding with no identifiable organic cause.'

Template 4

Template: 'Treatment plan includes hormonal therapy for management of abnormal menses.'

Billing Information

Billing Considerations

Ensure proper documentation for billing
Verify code specificity requirements
Check for any additional codes needed
Review payer-specific guidelines

Common Issues

Insufficient clinical documentation
Incorrect code selection
Missing supporting diagnoses
Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this code?

Documentation should include a detailed menstrual history, physical exam findings, and any relevant lab results.

When should this code be used vs similar codes?

Use this code for abnormal menstrual patterns; consider other codes for specific underlying conditions.

What are common billing issues with this code?

Reimbursement issues may arise from insufficient documentation; ensure all clinical findings are well-documented.

What procedures are commonly associated?

Related CPT codes may include pelvic ultrasound (76856) and endometrial biopsy (58100) for further evaluation.

What is Abnormal Menses?

Key Clinical Considerations:

Diagnosis of abnormal menses requires a thorough menstrual history, including cycle regularity, duration, and volume of bleeding.
Signs and symptoms may include changes in menstrual cycle frequency, heavy menstrual bleeding, or intermenstrual bleeding.
Resolution criteria may involve normalization of menstrual cycles following treatment or lifestyle changes.
Laboratory findings may include hormonal assays, complete blood count (CBC) for anemia, and imaging studies like ultrasound to assess structural abnormalities.

Abnormal Menses

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Template 1

Template 2

Template 3

Template 4

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

What documentation is required for this code?

When should this code be used vs similar codes?

What are common billing issues with this code?

What procedures are commonly associated?

Abnormal Menses

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Template 1

Template 2

Template 3

Template 4

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

What documentation is required for this code?

When should this code be used vs similar codes?

What are common billing issues with this code?

What procedures are commonly associated?