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ICD-10 Guide
DiagnosesAmenorrhea

Amenorrhea

ICD-10 Coding for Amenorrhea(N91.0, N91.1, N91.2)

PRIMARY SPECIALTYGynecology
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Amenorrhea?
Essential facts and insights about Amenorrhea

Key Clinical Considerations:

  • Absence of menstruation for three consecutive cycles or for a duration of six months in women of reproductive age.
  • Laboratory findings may include hormonal assays showing low estrogen levels or elevated gonadotropins.
  • Physical examination may reveal signs of underlying conditions such as polycystic ovary syndrome (PCOS) or hypothalamic amenorrhea.
  • Imaging studies like pelvic ultrasound may show ovarian cysts or structural abnormalities.
  • Severity criteria may include the duration of amenorrhea and associated symptoms such as weight changes or hirsutism.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Medical records must document the duration of amenorrhea and any associated symptoms.
  • Specific terminology such as 'primary amenorrhea' or 'secondary amenorrhea' must be used appropriately.
  • Documentation examples include noting the patient's menstrual history and any relevant hormonal test results.
  • Medical necessity must be established through documentation of symptoms and the impact on the patient's health.
  • Quality measures may require tracking of menstrual cycle regularity and associated health outcomes.

Coding Guidelines

Usage Guidelines & Examples

  • Use N91.0 for primary amenorrhea in patients who have never menstruated by age 16.
  • Do not use this code for patients with amenorrhea due to pregnancy or menopause.
  • N91.1 is for secondary amenorrhea, which is when menstruation ceases after previously normal cycles.
  • Common coding errors include misclassifying primary vs. secondary amenorrhea; ensure accurate patient history.
  • In complex cases, consider comorbid conditions that may affect menstrual cycles, such as thyroid disorders.

Code Exclusions

Important Exclusions

  • Excludes conditions such as pregnancy (Z33.1) and menopause (N95.1).
  • Alternative codes for excluded conditions include Z32.0 for pregnancy testing.
  • Conditions are excluded to avoid misdiagnosis and ensure appropriate treatment pathways.
  • Common exclusion mistakes include failing to confirm pregnancy status before coding amenorrhea.
  • Related but distinct conditions include oligomenorrhea (N91.4) and dysmenorrhea (N94.6).

Related ICD-10 Codes

Primary Codes
N91.0
Primary amenorrhea
N91.1
Secondary amenorrhea
N91.2
Amenorrhea, unspecified
Ancillary Codes
E28.3
E28.2
Differential Codes
E28.3
E28.2
N91.0
N91.1

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Gynecology

Specialty Applications

  • Applies to women of reproductive age experiencing menstrual irregularities.
  • Patient populations include adolescents with primary amenorrhea and adults with secondary amenorrhea.
  • Clinical settings include outpatient gynecology clinics and endocrinology practices.
  • Specialty-specific applications are relevant in reproductive endocrinology and fertility treatments.
  • Treatment contexts may involve hormonal therapy, lifestyle modifications, or addressing underlying conditions.

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: 'Patient diagnosed with amenorrhea based on absence of menstruation for [duration].'

Template 2

Template: 'Clinical presentation consistent with secondary amenorrhea including [symptoms].'

Template 3

Template: 'Diagnostic criteria for amenorrhea met as evidenced by [specific findings].'

Template 4

Template: 'Treatment plan initiated for amenorrhea with [interventions].'

Template 5

Template: 'Follow-up care for amenorrhea including monitoring of [parameters].'

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 diagnosis?

Document the patient's menstrual history, duration of amenorrhea, and any relevant symptoms.

How does this differ from similar diagnoses?

Primary amenorrhea is diagnosed when menstruation has not occurred by age 16, while secondary amenorrhea occurs after established cycles.

What are common billing considerations?

Ensure that the diagnosis is supported by medical necessity and that all relevant symptoms are documented.

What procedures are typically associated?

Related CPT codes may include hormonal assays, pelvic ultrasounds, and other diagnostic tests.

Are there any quality reporting implications?

Quality measures may include tracking menstrual cycle regularity and treatment outcomes.