ICD-10 Coding for Premenstrual Syndrome(N94.3)
Complete ICD-10-CM coding and documentation guide for Premenstrual Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Premenstrual Syndrome
N94.3Primary Range
Premenstrual tension syndrome
This code is used for diagnosing premenstrual syndrome, capturing the cyclic nature of symptoms related to the menstrual cycle.
Key Information: ICD-10 code for premenstrual syndrome
Essential facts and insights about Premenstrual Syndrome
Primary ICD-10-CM Code for premenstrual syndrome
Decision Criteria
clinical Criteria
- Symptoms must occur cyclically and resolve post-menses.
documentation Criteria
- Document specific symptoms, timing, and impact.
Applicable To
- Premenstrual syndrome
Clinical Validation Requirements
- Symptoms occur cyclically in the luteal phase (5–14 days pre-menses)
- Symptoms resolve within 4 days of menses onset
- Symptoms impair daily functioning
Code-Specific Risks
- Incorrectly coding without confirming cyclic pattern
- Missing documentation of symptom impact
Coding Notes
- Ensure documentation specifies cyclic nature and impact on daily activities.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Premenstrual Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N94.3.
Impact
Clinical: Inaccurate diagnosis, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Use symptom diaries, Educate staff on documentation standards
Impact
Reimbursement: May lead to denied claims due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Use N94.3 with documented cyclic symptoms.
Impact
Lack of detailed symptom logs can trigger audits.
Mitigation Strategy
Ensure comprehensive documentation of symptoms and their cyclic nature.
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 Premenstrual Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Premenstrual Syndrome
Use these documentation templates to ensure complete and accurate documentation for Premenstrual Syndrome. These templates include all required elements for proper coding and billing.
PMS diagnosis and management
Specialty: OB/GYNRequired Elements
- Symptom description
- Cyclic pattern
- Impact on daily life
- Exclusion of other conditions
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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