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ICD-10 Guide
ICD-10 CodesChapter 14: Diseases of the genitourinary systemN95

N95

Billable

Menopausal and other perimenopausal disorders

Chapter 14:Diseases of the genitourinary system

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

Code Description

ICD-10 N95 is a billable code used to indicate a diagnosis of menopausal and other perimenopausal disorders.

Key Diagnostic Point:

Menopausal and other perimenopausal disorders encompass a range of conditions that occur during the transition to menopause, typically affecting women aged 45 to 55. This period, known as perimenopause, is characterized by hormonal fluctuations that can lead to various symptoms and health issues. Common manifestations include irregular menstrual cycles, hot flashes, night sweats, mood changes, and vaginal dryness. These symptoms can significantly impact a woman's quality of life. Additionally, menopausal disorders may include complications related to female infertility, as hormonal changes can affect ovulation and fertility. Conditions such as anovulation, polycystic ovary syndrome (PCOS), and premature ovarian insufficiency may also be classified under this code. Furthermore, complications arising from artificial fertilization procedures, such as ovarian hyperstimulation syndrome (OHSS), may be relevant. Accurate coding requires a thorough understanding of the patient's clinical presentation and history, as well as the specific symptoms and disorders being addressed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptoms and severity among patients
  • Overlap with other gynecological conditions
  • Need for precise documentation of hormonal status
  • Potential for co-existing conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of symptoms
  • Failure to specify the type of menopausal disorder
  • Misclassification of perimenopausal symptoms as menopausal
  • Lack of supporting clinical evidence for infertility diagnoses

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed patient history, including menstrual cycle patterns, symptom severity, and any treatments administered.

Common Clinical Scenarios

Patients presenting with hot flashes, irregular periods, or seeking fertility treatments.

Billing Considerations

Ensure clear documentation of the patient's menopausal status and any related conditions to avoid misclassification.

Reproductive Endocrinology

Documentation Requirements

Comprehensive evaluation of hormonal levels, fertility assessments, and treatment plans.

Common Clinical Scenarios

Patients undergoing artificial fertilization or presenting with infertility issues.

Billing Considerations

Document all hormonal therapies and their effects on the patient's reproductive health.

Coding Guidelines

Inclusion Criteria

Use N95 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the patient's symptoms and any related conditions
  • Include specific details about the type of menopausal disorder and any treatments provided

Exclusion Criteria

Do NOT use N95 When
No specific exclusions found.

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits for menopausal symptom management.

Documentation Requirements

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

Specialty Considerations

Obstetrics and Gynecology specialists should ensure comprehensive documentation of all relevant symptoms.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of menopausal and perimenopausal disorders, improving the accuracy of diagnoses and treatment tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of menopausal and perimenopausal disorders, improving the accuracy of diagnoses and treatment tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of menopausal and perimenopausal disorders, improving the accuracy of diagnoses and treatment tracking.

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

What symptoms are included under N95?

N95 includes symptoms such as hot flashes, night sweats, mood changes, and irregular menstrual cycles associated with menopause and perimenopause.