ICD-10 Coding for Hormone Replacement Therapy
The ICD-10 code for prescribing estradiol and progesterone as hormone replacement therapy is Z79.890 (Hormone replacement therapy [postmenopausal]).
Primary Coding
For patients receiving estradiol and/or progesterone for menopausal hormone therapy, the appropriate ICD-10 code is:
- Z79.890: Hormone replacement therapy (postmenopausal)
This code should be used as a secondary diagnosis to document ongoing HRT use in postmenopausal women receiving FDA-approved estradiol preparations 1 and progesterone 2.
Additional Relevant Codes
Depending on the clinical indication, you may also need to include:
- N95.1: Menopausal and female climacteric states (for vasomotor symptoms, hot flashes)
- N95.2: Postmenopausal atrophic vaginitis
- E28.310: Symptomatic premature menopause (if applicable)
- Z90.710: Acquired absence of both cervix and uterus (for estrogen-only therapy without need for progesterone)
Clinical Context for Coding
The specific formulation matters for documentation purposes:
Oral estradiol (0.5 mg, 1 mg tablets) 1 combined with oral micronized progesterone (typically 200-300 mg daily) 2 represents the most physiologically appropriate regimen, as progesterone is required in women with an intact uterus to prevent endometrial hyperplasia 3.
Transdermal estradiol may be preferable in women with VTE risk, hypertension, hypertriglyceridemia, obesity, or diabetes 3, though the same Z79.890 code applies.
Important Coding Considerations
Always document whether the patient has an intact uterus, as this determines whether progesterone is medically necessary. Women with a uterus require progestogen to prevent endometrial hyperplasia and cancer 3. The progesterone prevents the 64% risk of endometrial hyperplasia seen with unopposed estrogen 2.
For billing and documentation purposes, ensure the medical record clearly indicates:
- The specific indication (menopausal symptoms, prevention of osteoporosis, etc.)
- Whether the patient has undergone hysterectomy
- The specific formulation prescribed (oral vs. transdermal estradiol; micronized progesterone vs. synthetic progestins)
Use only FDA-approved preparations rather than custom-compounded hormones, as recommended by clinical practice guidelines 3.