What is the ICD-10 (International Classification of Diseases, 10th Revision) code for low estrogen levels?

ICD-10 Code for Low Estrogen Levels

The appropriate ICD-10 code for low estrogen levels is E28.319 (Primary ovarian failure, unspecified).

Understanding Low Estrogen and Coding Options

Low estrogen levels can occur in various clinical contexts, including:

1. Primary ovarian insufficiency/failure - When the ovaries fail to produce adequate estrogen
2. Hypothalamic-pituitary dysfunction - When central regulation of ovarian function is impaired
3. Post-surgical states - Following oophorectomy
4. Age-related decline - Natural menopause

Coding Algorithm:

1. If due to primary ovarian failure:

   • E28.319 (Primary ovarian failure, unspecified)
   • E28.310 (Symptomatic premature menopause) - if patient is experiencing symptoms
   • E28.39 (Other primary ovarian failure) - for specified types

2. If due to hypothalamic-pituitary dysfunction:

   • E23.0 (Hypopituitarism) - when central hypogonadism is present

3. If post-surgical:

   • E89.40 (Asymptomatic postprocedural ovarian failure)
   • E89.41 (Symptomatic postprocedural ovarian failure)

4. If age-appropriate menopause:

   • N95.1 (Menopausal and female climacteric states)

Clinical Manifestations of Low Estrogen

Low estrogen levels can lead to various symptoms and complications 1:

• Menstrual irregularities (oligomenorrhea or amenorrhea)
• Vasomotor symptoms (hot flashes)
• Vaginal dryness and atrophy
• Decreased bone mineral density
• Sexual dysfunction
• Cognitive changes

Laboratory Assessment

When documenting low estrogen levels, include:

• Serum estradiol levels (typically <20 pg/ml indicates low levels) 1
• Associated hormone levels (FSH, LH, SHBG)
• Presence of symptoms

Clinical Considerations

In women with advanced liver disease, altered estrogen metabolism and disruption of the hypothalamic-pituitary axis can lead to anovulation, amenorrhea, and infertility 1. These patients may present with amenorrhea or oligomenorrhea, seen in more than 25% of women with advanced liver disease.

For women with symptoms of vaginal and vulvar atrophy due to low estrogen, a stepwise approach to treatment is recommended 1:

1. Lubricants and vaginal moisturizers
2. Low-dose vaginal estrogen (when appropriate)
3. Lidocaine for persistent pain
4. Vaginal DHEA for those not responding to other treatments

Coding Pitfalls to Avoid

1. Don't use symptom codes alone (N95.0 for postmenopausal bleeding, N95.2 for atrophic vaginitis) without the underlying cause code

2. Don't confuse with polycystic ovary syndrome (E28.2), which typically presents with high androgen levels

3. Don't use E28.8 (Other ovarian dysfunction) as this is less specific than codes for ovarian failure

4. Avoid using N95.1 (Menopausal state) for premature ovarian failure, as this is less specific and doesn't capture the pathological nature of the condition

When documenting low estrogen, always specify the cause when known, as this will guide the most appropriate ICD-10 code selection and subsequent treatment planning.