Coding for Menstrual Disorders
For The Record
Vol. 17 No. 25 P. 34

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

Premenstrual Syndrome
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, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, oral contraceptives, and diuretics. PMS is classified to ICD-9-CM 625.4. Other terms synonymous with PMS are prementstrual tension syndrome, premenstrual tension, and late luteal phase dysphoric disorder.

Premenstrual Dysphoric Disorder
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. PMDD is indexed to code 625.4.

Dysmenorrhea
Dysmenorrhea (625.3), also known as 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, 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 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.

Amenorrhea
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 of secondary amenorrhea include pregnancy, thyroid problems, stress, anorexia nervosa, and excessive exercise. Primary and secondary amenorrhea 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 is following an induced menopause, assign code 627.4.

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

Menorrhagia
Menorrhagia is excessive (heavy or prolonged) bleeding occurring at the regular time of the menstruation. Common causes of menorrhagia include stress, vaginal disease or injury, variation in hormone levels, low thyroid function, and stopping or starting birth control pills.

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.

Polymenorrhea and Menometrorrhagia
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.

Metrorrhagia
Metrorrhagia, also called irregular intermenstrual bleeding, is bleeding occurring at irregular intervals with normal to prolonged flow. The bleeding is unrelated to the menstrual cycle.

Metrorrhagia 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.

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

Coding and sequencing for menstrual disorders are dependent upon 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 Health Information Systems (800-367-2447), a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information.

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