# Amenorrhea



## TracieHewitt (Oct 20, 2009)

I have never posted anything on here, but I'm going to give it a shot. Here goes...

If a patient comes to see the OB/GYN with a dx of amenorrhea and the physician performs H&P, exam etc and the patien has a positive pregnancy test....Can the physician bill this with the appropriate E&M level and list a dx of 626.0? or should the OB/GYN consider this the first episode of pregnancy care and consider this part of the Antepartum care?


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## kathymoon (Oct 20, 2009)

I just finished an article from the OB-GYN Coding Alert.  It states that this is not part of the OB care.  Per this article: "You must report what you know at the end of any visit.  If the ob-gyn knows the patient is pregnant, you must report the patient as pregnant.  Code V72.42 suffices because the pregnancy care has not begun."  "Should not begin the ob record until the next visit."  Hope this helps.
Kathy


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## TracieHewitt (Oct 20, 2009)

Kathy, thank you so much.  That's what I was thinking, but I was getting a little static over it.  Good to have someone to back me up.


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## mitchellde (Oct 20, 2009)

626.0 is a code in the chapter for diseases disorders of the genitourinary system.  If the physician documetation is using the term amenorrhea as a symptom of missed periods or just states missed periods then this is not the correct code.  626.0 has definition of absence of menses prior to the age of 15 or for a period of 6 months or greater.   In fact there is nothing "wrong" with the patient so the V72.4x is the correct dx.  And this too matches the reason for the encounter and the dx after study.


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## Rgreen0118 (Oct 21, 2009)

My suggestion is to use 626.8 (missed period) and then V72.42 for this visit so the insurance company will not try to bundle this into the global period.

Rhonda,CPC


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## mitchellde (Oct 22, 2009)

The dx code 626.8 Other disorders of menstruation and other abnormal bleeding from female genital tract, is not a code for a pt that has missed a period due to the probability of pregnancy.  Again this code is in the chapter for diseases and disorders of the genitourinary tract,  this chapter does not match the reason the  physician documents as the reason for the encounter.  The V72.4x is the only coded needed for this encounter, if the payer declines reimbursement due to coverage then the patient will be responsible.  We need to refrain from giving dx codes that the patient does not have in order to get the claim paid.


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## kumeena (Oct 22, 2009)

How about less than 6months(about 2-3 months) without period? Doctor writes Amenorrhea (is it write spelling)?how do you code?

Thanks


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## mitchellde (Oct 22, 2009)

Does the physician document a test for pregnancy and a possibility of pregnancy as the cause for the missed periods?  Or is the patient possibly menopausal?  you need to look at what is driving the physican to say amenorrhea.


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## kumeena (Oct 23, 2009)

mitchellde said:


> Does the physician document a test for pregnancy and a possibility of pregnancy as the cause for the missed periods?  Or is the patient possibly menopausal?  you need to look at what is driving the physican to say amenorrhea.



Not really. Sometimes patient ages between 25 -35. Diagnosis is  Amenorrhea and plan is order for blood test (TSH)

Thanks for your help


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## mitchellde (Oct 24, 2009)

I agree but we need to be certain from the documentation before we use that code, if it is due to the probability of pregnancy then 626.x codes are not the correct choice.  If as you state it is only 2-3 months and not for pregnancy then we need to maybe query for better documentation.  However in my experience the physician will do a pregnancy test and if negative will send the patient for a Beta Hcg which takes time to get a result, I would code the encounter for the pregnancy test as V72.40 for unconfirmed and go from there as the visits progress and the documentation becomes more specific.


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## bonnyr (Oct 29, 2009)

The other item to beware of is if the provider begins the prenatal record with the positive UCG, then this visit is included in the GLobal OB care.  Of course if they change plans or terminate you revert back to the E&M code.


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## Prasanna Subbulakshmi (Jul 8, 2019)

Please anyone reply me irregular menstruation and amenorrhea can code together in the same visit


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