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ICD-10 Coding for Missed Menses(N91.0, N91.1)

Complete ICD-10-CM coding and documentation guide for Missed Menses. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

AmenorrheaAbsence of Menstruation

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Related ICD-10 Code Ranges

Complete code families applicable to Missed Menses

N91.0-N91.2Primary Range

Amenorrhea

This range covers primary and secondary amenorrhea, which are the main conditions associated with missed menses.

E28.3

Polycystic ovarian syndrome

PCOS is a common underlying cause of secondary amenorrhea.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
N91.0Primary amenorrheaUse when a patient has not started menstruating by age 15 with secondary sexual characteristics or by age 16 without them.
  • No prior menstrual history
  • Tanner stage assessment
  • Pelvic ultrasound findings
N91.1Secondary amenorrheaUse for patients who have missed three or more consecutive menstrual cycles after previously having regular periods.
  • Documented absence of menstruation for at least 3 months
  • Negative pregnancy test
  • Exclusion of menopause

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 missed menses

Essential facts and insights about Missed Menses

The ICD-10 codes for missed menses are N91.0 for primary amenorrhea and N91.1 for secondary amenorrhea.

Primary ICD-10-CM Codes for missed menses

N91.0
Primary amenorrhea
Billable Code

Decision Criteria

clinical Criteria

  • No menarche by age 15 with secondary sexual characteristics
  • No menarche by age 16 regardless of puberty status

Applicable To

  • No menarche by age 15 with secondary sexual characteristics
  • No menarche by age 16 regardless of puberty status

Excludes

  • Ovarian dysfunction (E28.-)

Clinical Validation Requirements

  • No prior menstrual history
  • Tanner stage assessment
  • Pelvic ultrasound findings

Code-Specific Risks

  • Misclassification if puberty assessment is incomplete

Coding Notes

  • Ensure thorough documentation of puberty development and any underlying conditions.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Polycystic ovarian syndrome

E28.3
Use when PCOS is confirmed as the underlying cause.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Irregular menstruation

N92.6
Use N92.6 for irregular cycles, not complete absence of menstruation.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Missed Menses to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N91.0.

Impact

Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with coding guidelines., Financial: Potential claim denials due to incomplete documentation.

Mitigation Strategy

Always perform and document a pregnancy test for amenorrhea cases.

Impact

Reimbursement: Incorrect coding can lead to denied claims., Compliance: Misclassification affects data accuracy., Data Quality: Impacts clinical decision-making and patient records.

Mitigation Strategy

Use N92.0 for oligomenorrhea unless there are 3 or more missed cycles.

Impact

Incomplete menstrual history can lead to audit findings.

Mitigation Strategy

Ensure comprehensive documentation of menstrual history and exclusion criteria.

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 Missed Menses, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Missed Menses

Use these documentation templates to ensure complete and accurate documentation for Missed Menses. These templates include all required elements for proper coding and billing.

Secondary Amenorrhea Evaluation

Specialty: OB/GYN

Required Elements

  • Menstrual history
  • Last menstrual period
  • Pregnancy test results
  • Hormonal assay results

Example Documentation

Patient presents with secondary amenorrhea. LMP was 01/15/2025. Negative pregnancy test. FSH and LH levels within normal range.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has missed periods.
Good Documentation Example
Patient, age 25, has not menstruated for 4 months. LMP was 01/15/2025. Negative pregnancy test. FSH 5 mIU/mL, LH 6 mIU/mL.
Explanation
The good example provides specific details about the menstrual history, test results, and excludes pregnancy.

Need help with ICD-10 coding for Missed Menses? Ask your questions below.

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