ICD-10 Coding for Dysmenorrhea(N94.4, N94.5, N94.6)
Complete ICD-10-CM coding and documentation guide for Dysmenorrhea. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Dysmenorrhea
N94.4-N94.6Primary Range
Pain and other conditions associated with female genital organs and menstrual cycle
This range includes codes specifically for dysmenorrhea, distinguishing between primary, secondary, and unspecified types.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N94.4 | Primary dysmenorrhea | Use when dysmenorrhea is confirmed without any pelvic pathology. |
|
| N94.5 | Secondary dysmenorrhea | Use when dysmenorrhea is associated with conditions like endometriosis. |
|
| N94.6 | Unspecified dysmenorrhea | Use when documentation does not specify primary or secondary dysmenorrhea. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for primary dysmenorrhea
Essential facts and insights about Dysmenorrhea
Primary ICD-10-CM Codes for dysmenorrhea
Decision Criteria
clinical Criteria
- No pelvic pathology identified
Applicable To
- Menstrual cramps without pelvic pathology
Excludes
- Secondary dysmenorrhea (N94.5)
Clinical Validation Requirements
- Normal pelvic exam
- No imaging abnormalities
Code-Specific Risks
- Incorrectly coding primary when secondary causes are present.
Coding Notes
- Ensure documentation specifies 'primary dysmenorrhea' and absence of secondary causes.
N94.5 - Secondary dysmenorrhea
Use when dysmenorrhea is associated with conditions like endometriosis.
Applicable To
- Dysmenorrhea due to endometriosis or fibroids
Excludes
- Primary dysmenorrhea (N94.4)
Clinical Validation Requirements
- Imaging or lab confirmation of pelvic pathology
Coding Notes
Link dysmenorrhea to the specific secondary condition.
N94.6 - Unspecified dysmenorrhea
Use when documentation does not specify primary or secondary dysmenorrhea.
Applicable To
- Dysmenorrhea not otherwise specified
Clinical Validation Requirements
- Insufficient documentation to specify primary or secondary
Coding Notes
Encourage providers to specify primary or secondary to avoid unspecified coding.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Dysmenorrhea to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N94.4.
Impact
Clinical: May lead to inappropriate treatment, Regulatory: Increases risk of audit, Financial: Potential for denied claims
Mitigation Strategy
Train providers on specific documentation requirements, Use structured templates
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit due to lack of specificity., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Ensure documentation specifies primary or secondary dysmenorrhea.
Impact
Using N94.6 when more specific codes are applicable.
Mitigation Strategy
Encourage detailed documentation to support specific coding.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Dysmenorrhea, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Dysmenorrhea
Use these documentation templates to ensure complete and accurate documentation for Dysmenorrhea. These templates include all required elements for proper coding and billing.
Chronic dysmenorrhea evaluation
Specialty: GynecologyRequired Elements
- History of present illness
- Menstrual history
- Physical exam findings
- Diagnostic test results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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