ICD-10-CM Code for Progesterone Hormone Replacement Therapy
The ICD-10-CM code for progesterone hormone replacement therapy is Z79.890 (Hormone replacement therapy [postmenopausal]).
Primary Coding
- Z79.890 is the appropriate code for patients receiving hormone replacement therapy, including progesterone as part of postmenopausal HRT regimens 1
- This code applies whether progesterone is used alone or in combination with estrogen for endometrial protection 1
Additional Relevant Codes
- Z78.0 may be used as a secondary code if documenting asymptomatic menopausal state 2
- E28.310 should be used if the indication is premature ovarian insufficiency (POI), as this represents the underlying diagnosis requiring HRT 2, 1
- N95.1 can be used for menopausal and female climacteric states if vasomotor symptoms are the primary indication 2
Clinical Context for Coding
- The code Z79.890 is used for long-term (current) hormone replacement therapy, not for short-term or acute prescriptions 1
- When progesterone is prescribed for contraception rather than HRT, use Z30.41 (Encounter for surveillance of contraceptive pills) instead 2
- For women with premature ovarian insufficiency requiring HRT until age 45-55 years, both E28.310 and Z79.890 should be documented 2, 1
Documentation Requirements
- Medical records should specify the type of progesterone (micronized progesterone, medroxyprogesterone acetate, or dydrogesterone) and whether it is sequential (12-14 days/month) or continuous daily dosing 1
- Document whether the patient has an intact uterus, as this justifies the medical necessity of progesterone for endometrial protection when combined with estrogen 1
- Annual clinical reviews should be documented with reassessment of risks versus benefits to support ongoing medical necessity 1, 3