What are the procedure codes for irregular menstrual bleeding appointments?

Procedure Codes for Irregular Menstrual Bleeding Appointments

The primary procedure codes for irregular menstrual bleeding appointments include CPT codes 99201-99215 for office visits, with specific diagnostic codes N92.0-N92.6 from the ICD-10-CM classification system for various types of menstrual bleeding irregularities. 1

Office Visit Procedure Codes

• Evaluation and Management (E/M) Codes:
  • 99201-99205: New patient office visits (varying complexity)
  • 99211-99215: Established patient office visits (varying complexity)

Diagnostic Codes (ICD-10-CM)

• N92.0: Excessive and frequent menstruation with regular cycle
• N92.1: Excessive and frequent menstruation with irregular cycle
• N92.2: Excessive menstruation at puberty
• N92.3: Ovulation bleeding
• N92.4: Excessive bleeding in the premenopausal period
• N92.5: Other specified irregular menstruation
• N92.6: Irregular menstruation, unspecified

Common Diagnostic Procedures and Their Codes

• 81025: Urine pregnancy test
• 84702: Quantitative HCG
• 84443: Thyroid stimulating hormone (TSH)
• 85610: Prothrombin time (PT)
• 85730: Partial thromboplastin time (PTT)
• 85246: Von Willebrand factor activity
• 76830: Transvaginal ultrasound
• 76856/76857: Pelvic ultrasound
• 58100: Endometrial biopsy
• 58558: Hysteroscopy with biopsy

Management Procedure Codes

• 58300: Insertion of intrauterine device (IUD) - particularly relevant for LNG-IUD which is effective for menorrhagia 1
• J1050: Injection, medroxyprogesterone acetate (DMPA)
• 58340: Saline infusion sonohysterography
• 58555: Diagnostic hysteroscopy
• 58563: Hysteroscopic endometrial ablation

Important Coding Considerations

1. Specificity is crucial: Use the most specific ICD-10 code that accurately reflects the patient's condition (e.g., N92.0 vs. N92.1)

2. Document thoroughly: Include details about:

   • Pattern of bleeding (heavy, prolonged, frequent, irregular)
   • Duration of symptoms
   • Associated symptoms
   • Previous treatments tried

3. Combination coding: When irregular bleeding is due to an underlying condition (e.g., PCOS, thyroid dysfunction), code both the bleeding pattern and the underlying condition 2

4. Modifier usage: Add appropriate modifiers when multiple procedures are performed during the same visit

5. Common pitfalls to avoid:

   • Using unspecified codes when more specific ones are available
   • Failing to link diagnostic procedures to the appropriate diagnosis
   • Not documenting medical necessity for advanced imaging or procedures
   • Overlooking the need for prior authorization for certain diagnostic procedures

Remember that accurate coding is essential for proper reimbursement and to establish medical necessity for diagnostic procedures and treatments for irregular menstrual bleeding 1, 2.