June 7, 2010

Coding for Menstrual Disorders
For The Record
Vol. 22 No. 11 P. 27

The following are the ICD-9-CM code assignments of common menstrual disorders:

• Amenorrhea (626.0) is the absence of normal menstruation. There are two types of amenorrhea: primary and secondary. Primary amenorrhea is when menstruation doesn’t start before the age of 16. Genetic problems, excessive exercise, or anorexia nervosa may cause primary amenorrhea. Secondary amenorrhea is when menstruation ceases for at least three months. Causes include pregnancy, breast-feeding, extreme weight loss, thyroid problems, pituitary dysfunction, adrenal gland dysfunction, and ovarian cysts. Primary and secondary amenorrheas are included in code 626.0. If the amenorrhea is due to ovarian dysfunction, assign code 256.8 instead. Menopausal or postmenopausal amenorrhea is assigned to code 627.2. If it follows an induced menopause, assign code 627.4.

• Dysfunctional uterine bleeding (626.8) is abnormal bleeding resulting from hormonal changes most often caused by irregular ovulation. The uterine lining thickens and causes irregular, prolonged, and excessive bleeding. Treatment of dysfunctional uterine bleeding depends on a patient’s age and the condition’s severity. Treatment can range from iron supplements to hormonal treatments (birth control pills) to dilation and curettage to a hysterectomy.

• Dysmenorrhea (625.3), or menstrual cramps, is abdominal pain caused by uterine cramps during a menstrual cycle. Primary dysmenorrhea is diagnosed when no other underlying cause for the painful menstruation can be determined. Secondary dysmenorrhea is menstrual pain caused by a specific gynecologic disorder such as endometriosis, an ovarian cyst, or pelvic inflammatory disease. The pain starts shortly before or during the menstrual cycle and usually subsides in 48 hours. The most effective treatments for primary dysmenorrhea are nonsteriodal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen and birth control pills. Sufficient rest, exercise, and a balanced diet may also reduce the pain. The treatment for secondary dysmenorrhea depends on the cause.

• Hypomenorrhea is the abnormally light volume of a regular menstrual flow. Oligomenorrhea is the decreased frequency of menstruation. Both are classified to code 626.1.

• Menorrhagia is excessive (heavy or prolonged) bleeding occurring at the regular time of the menstruation. Common causes of menorrhagia include a hormone imbalance, fibroid tumors, lupus, pelvic inflammatory disease, cervical cancer, and endometrial cancer. Menorrhagia is assigned to code 626.2. Pubertal menorrhagia, which is the excessive bleeding associated with the onset of menstrual periods, is classified to code 626.3. Code 627.0 is assigned for menorrhagia documented as premenopausal, climacteric, menopausal, or preclimacteric. Postmenopausal menorrhagia is assigned to code 627.1 or code 627.4 if the menopause was induced.

• Metrorrhagia, also called irregular intermenstrual bleeding, is bleeding that occurs at irregular intervals with normal to prolonged flow. This bleeding, unrelated to the menstrual cycle, is classified to code 626.6. If the metrorrhagia is bleeding associated with ovulation or documented as regular intermenstrual bleeding, assign code 626.5. If the metrorrhagia is associated with pregnancy, assign the appropriate code from the pregnancy chapter in ICD-9-CM. Psychogenic metrorrhagia is assigned to code 306.59.

Premenstrual syndrome (PMS) is the emotional and physical symptoms women experience seven to 14 days before a menstrual period begins. Symptoms include irritability, bloating, breast tenderness, headaches, backaches, dizziness, mood swings, and depression that stop at the onset of the menstrual period. Treatment of PMS includes a well-balanced diet (low in sugar and caffeine and high in carbohydrates), dietary supplements, exercise, NSAIDs, antidepressants, oral contraceptives, and diuretics. PMS is classified to ICD-9-CM code 625.4. Other terms synonymous with PMS are premenstrual tension syndrome, premenstrual tension, and menstrual molimen.

• Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS. Symptoms include depression, pain, tension, irritability, and anxiety. PMDD may be treated with medroxyprogesterone acetate (Depo-Provera), an injection used to temporarily stop ovulation, and is indexed to code 625.4.

• Polymenorrhea is frequent, irregular bleeding occurring in less than an 18-day cycle. Menometrorrhagia is heavy or prolonged irregular periods. Polymenorrhea and menometrorrhagia are assigned to code 626.2 and follow the same coding exceptions as menorrhagia. Therefore, pubertal polymenorrhea and menometrorrhagia are assigned to code 626.3. Code 627.0 is assigned for polymenorrhea and menometrorrhagia documented as premenopausal, climacteric, menopausal, or preclimacteric. Postmenopausal polymenorrhea and menometrorrhagia are assigned to code 627.1 or code 627.4 if the menopause was induced.

Coding and sequencing for menstrual disorders are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.