Learn to Report Primary and Secondary

Amenorrhea in ICD-10
By Susan Dooley

When you break the medical word amenorrhea down into its component parts, it simply means without
[a-] menstrual [meno-] flow [-rrhea], or having no menstrual periods. Of course, amenorrhea is a
normal condition when women havent gone through puberty yet, are pregnant, or are
postmenopausal. For women of childbearing ages, however, diagnosis of amenorrhea depends first on
determining whether pregnancy is its cause. With pregnancy excluded, the next diagnostic challenge is
figuring out what exactly is causing the menses to be absent.

Diagnosing Primary and Secondary Amenorrhea and Oligomenorrhea

Clinicians diagnose primary amenorrhea when a woman has reached age 16 without having menses,
while still having normal growth and secondary sexual characteristics such as breast development.
Secondary amenorrhea occurs when menses cease some time after menarche occurs. A similar
condition, oligomenorrhea, is defined by menses that occur at time periods longer than 35 days apart.
Experts differ on the exact point when oligomenorrhea becomes amenorrhea, but most agree that in
women of childbearing ages, an absence of periods of more than three months merits medical
evaluation.

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Coding for Amenorrhea and Oligomenorrhea

Before ICD-10 came along, ICD-9 offered just one diagnosis code to describe the condition of absence of
menstruation. However, ICD-10-CM follows current medical practice of menstruation disorder diagnosis,
offering codes for primary and secondary amenorrhea as well as oligomenorrhea.

N91.0, Primary amenorrhea

N91.1, Secondary amenorrhea
N91.2, Amenorrhea, unspecified
N91.3, Primary oligomenorrhea
N91.4, Secondary oligomenorrhea
N91.5, Oligomenorrhea, unspecified.

When you look at category N91.- (Absent, scanty and rare menstruation) in your ICD-10-CM code book,
youll notice an Excludes1 note forbidding you from reporting any of these codes with ovarian
dysfunction (E28.-).

And Speaking of Excludes1 Notes

Remember back before ICD-10 was implemented, we learned in ICD-10 training that Excludes1 notes
were the equivalent of never code together? It turns out that there may be situations where it would
be appropriate to report a code together with codes from its Excludes1 list. Though the ICD-10-CM
Tabular List clearly specifies that an Excludes1 note indicates that the code excluded should never be
used at the same time as the code above the Excludes1 note, that rule caused issues for certain code
combinations.
For example, the Excludes1 note at code range R40-R46 states that symptoms and signs that are part of
a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46 codes. However, if dizziness
(R42) is not a component of the mental health condition, then separate codes may be assigned for both
dizziness and the mental health condition. An example of this would be when the symptom of dizziness
is unrelated to a diagnosed mental health condition, such as bipolar disorder. The four cooperating
parties of ICD-10 AHIMA, AHA, CMS, and NCHS issued this interim advice. Once the ICD-10 partial
code freeze expires on October 1, 2016, you may see some Excludes1 notes change to Excludes2 notes,
and the interim rule we just discussed may change as well.

What About You?

Have you run into any situations such as the one we mentioned above, where you needed to report
certain codes with their Excludes1 list? Write to us!

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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com