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ICD-10 Guide
ICD-10 CodesN94.9

N94.9

Billable

Unspecified condition associated with female genital organs and menstrual cycle

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

Code Description

ICD-10 N94.9 is a billable code used to indicate a diagnosis of unspecified condition associated with female genital organs and menstrual cycle.

Key Diagnostic Point:

N94.9 is used to classify unspecified conditions related to female genital organs and the menstrual cycle. This code encompasses a range of menstrual disorders, including irregular menstruation, dysmenorrhea (painful periods), and amenorrhea (absence of menstruation). It also includes menopausal disorders such as perimenopausal symptoms and complications arising from artificial fertilization procedures. Female infertility, which may stem from various underlying conditions affecting the reproductive system, is also captured under this code when the specific cause is not identified. The lack of specificity in this code can complicate clinical management and treatment planning, as it does not provide detailed information about the underlying pathology or the specific symptoms experienced by the patient. Therefore, it is crucial for healthcare providers to document any relevant clinical findings and patient history to support the use of this code effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Lack of specificity in the diagnosis
  • Variety of conditions that can be included under this code
  • Potential overlap with other codes related to menstrual and reproductive health
  • Need for comprehensive documentation to justify the use of this code

Audit Risk Factors

  • Insufficient documentation to support the unspecified diagnosis
  • Inconsistent use of the code across different providers
  • Failure to document the patient's symptoms and history adequately
  • Use of this code when a more specific diagnosis is available

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed patient history, including menstrual cycle patterns, symptoms, and any treatments attempted.

Common Clinical Scenarios

Patients presenting with irregular menstrual cycles, pelvic pain, or infertility without a clear diagnosis.

Billing Considerations

Ensure that all relevant clinical findings are documented to support the use of N94.9, especially when other specific codes may apply.

Reproductive Endocrinology

Documentation Requirements

Comprehensive evaluation of hormonal levels, imaging studies, and previous fertility treatments.

Common Clinical Scenarios

Patients undergoing evaluation for infertility where no specific cause has been identified.

Billing Considerations

Document all diagnostic tests and results to justify the use of N94.9, particularly in cases of unexplained infertility.

Coding Guidelines

Inclusion Criteria

Use N94.9 When
  • According to ICD
  • 10 coding guidelines, N94
  • 9 should be used when the specific condition affecting the female genital organs or menstrual cycle is not documented
  • Coders should ensure that all relevant clinical information is captured to support the use of this code, and it should not be used if a more specific diagnosis is available

Exclusion Criteria

Do NOT use N94.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

58150CPT Code

Endometrial biopsy

Clinical Scenario

Used when evaluating abnormal uterine bleeding or menstrual irregularities.

Documentation Requirements

Document the reason for the biopsy and any relevant patient history.

Specialty Considerations

Obstetricians should ensure that the indication for the procedure aligns with the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more detailed coding of conditions related to female reproductive health. However, the use of N94.9 may lead to less precise data collection, impacting research and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more detailed coding of conditions related to female reproductive health. However, the use of N94.9 may lead to less precise data collection, impacting research and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more detailed coding of conditions related to female reproductive health. However, the use of N94.9 may lead to less precise data collection, impacting research and treatment outcomes.

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 N94.9?

N94.9 should be used when a patient presents with symptoms related to female genital organs or menstrual cycle, but a specific diagnosis has not been established. Ensure that all relevant clinical information is documented to support the use of this code.