ICD-10 Coding for Hormonal Imbalance(E28.39, N95.1)
Complete ICD-10-CM coding and documentation guide for Hormonal Imbalance. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hormonal Imbalance
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E28.39 | Other ovarian dysfunction | Use when ovarian dysfunction is confirmed by lab tests indicating hormonal imbalance. |
|
| N95.1 | Menopausal and perimenopausal disorders | Use for natural menopause confirmed by clinical and lab findings. |
|
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 hormonal imbalance
Essential facts and insights about Hormonal Imbalance
Primary ICD-10-CM Codes for hormonal imbalance
Decision Criteria
clinical Criteria
- FSH >40 mIU/mL and estradiol <20 pg/mL
Applicable To
- Primary ovarian insufficiency
- Hyperandrogenism
Excludes
- Polycystic ovarian syndrome (E28.2)
Clinical Validation Requirements
- FSH >40 mIU/mL
- Estradiol <20 pg/mL
Code-Specific Risks
- Misclassification if lab results are not documented.
Coding Notes
- Ensure lab results are included to support the diagnosis.
N95.1 - Menopausal and perimenopausal disorders
Use for natural menopause confirmed by clinical and lab findings.
Applicable To
- Natural menopause
- Perimenopausal symptoms
Excludes
- Premature menopause (E28.39)
Clinical Validation Requirements
- FSH >25 mIU/mL
- Absence of menses ≥12 months
Coding Notes
Document absence of menses and elevated FSH levels.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hormonal Imbalance to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E28.39.
Impact
Clinical: Leads to misdiagnosis., Regulatory: Increases audit risk., Financial: Potential for denied claims.
Mitigation Strategy
Always include lab results in patient records., Verify documentation before submission.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit failures., Data Quality: Reduces accuracy of patient records.
Mitigation Strategy
Always document specific lab results to justify the use of specific codes.
Impact
Using unspecified codes without documentation.
Mitigation Strategy
Ensure all codes are supported by clinical documentation.
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 Hormonal Imbalance, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hormonal Imbalance
Use these documentation templates to ensure complete and accurate documentation for Hormonal Imbalance. These templates include all required elements for proper coding and billing.
Hormonal Imbalance in Women
Specialty: EndocrinologyRequired Elements
- Patient symptoms
- Lab results
- Diagnosis
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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