Primary Care Coding Alert

Question: Our physician just saw a 39-year-old female patient and gave a diagnosis of hot flashes. Would it be correct to use N95.1 or would R23.2 be a better choice?

California Subscriber

Answer: Even though N95.1 (Menopausal and female climacteric states) features a note which states it includes “symptoms such as flushing, sleeplessness, headache, [and/or] lack of concentration, associated with natural (age-related) menopause,” the code would not be a good choice for a number of reasons.

First, the provider would have to document in the note that the patient was suffering from natural, age-related menopause. Second, given the patient’s age, it would be more likely that the provider would document a premature menopause. If the provider did document that the patient was indeed undergoing that condition, then you would code E28.310 (Symptomatic premature menopause), which contains a similar note that it includes “symptoms such as flushing, sleeplessness, headache, lack of concentration, associated with premature menopause.”

However, if there is no diagnosis of premature menopause, then R23.2 (Flushing) would be more correct. And if the flushing was accompanied by night sweats, as is often the case, then you could use R61 (Generalized hyperhidrosis) in addition.