ICD-10-CM code N95.1 is a crucial diagnosis code within the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) system. Specifically, N95.1 is designated to classify Menopausal and female climacteric states. This code is essential for medical coding, billing, and statistical tracking of health conditions related to menopause in women. Understanding the specifics of diagnosis code N95.1 is vital for healthcare professionals, medical coders, and anyone involved in women’s health.
Key Aspects of ICD-10 Code N95.1
Diagnosis code N95.1 holds several important characteristics within the ICD-10-CM framework:
Billable and Specific Code: N95.1 is recognized as a billable/specific code. This means it is precise enough to be used for claim reimbursements and accurately represents a specific medical diagnosis. It is not a general or non-specific code requiring further detail for billing purposes.
Effective Date: The 2025 edition of ICD-10-CM, which includes code N95.1, became effective on October 1, 2024. This date is critical for ensuring accurate coding and billing in healthcare settings. Using the correct code version for the date of service is essential for compliance and proper reimbursement.
American ICD-10-CM Version: It’s important to note that N95.1 as discussed here refers to the American ICD-10-CM version. ICD-10 is an international standard, and while the core code may be similar across different countries, specific versions like the American ICD-10-CM can have unique guidelines and annotations. International versions of ICD-10 N95.1 may have variations.
ICD-10-CM Coding Rules and Applications for N95.1
Applicable to Females: ICD-10-CM coding rules clearly state that N95.1 is exclusively applicable to female patients. This is inherent in the diagnosis itself, as menopause and climacteric states are biological processes specific to women.
Applicable Symptoms: Code N95.1 is appropriately used when patients present with symptoms associated with natural (age-related) menopause. These symptoms can include:
- Flushing (Hot Flashes): Sudden sensations of intense heat, often accompanied by sweating and redness of the skin.
- Sleeplessness (Insomnia): Difficulty falling asleep or staying asleep, a common complaint during the menopausal transition.
- Headache: Increased frequency or intensity of headaches can be related to hormonal changes during menopause.
- Lack of Concentration: Cognitive difficulties, including problems with focus and memory, can occur during this phase of life.
“Use Additional Code” Note: ICD-10-CM utilizes “use additional code” notes to provide guidance on coding related conditions. For N95.1, while not explicitly stated in the original article excerpt, it’s important to understand the principle. If a patient’s menopausal symptoms are secondary to another underlying condition, the guideline might suggest coding the underlying condition first, followed by N95.1. However, for typical age-related menopause, N95.1 is the primary diagnosis code. It’s also noted to “code for associated symptoms,” meaning if a patient has symptoms alongside menopause, these symptoms should also be coded separately if they are clinically significant.
“Type 1 Excludes” Note: The “type 1 excludes” note in ICD-10-CM is a strict exclusion rule. It signifies that the excluded condition should never be coded alongside N95.1. This usually applies when two conditions are mutually exclusive, such as congenital versus acquired forms of the same condition. While the specific “type 1 excludes” for N95.1 are not listed in the provided text, this rule is a general principle in ICD-10-CM coding to prevent contradictory coding.
Approximate Synonyms for Diagnosis Code N95.1
To further clarify the scope of N95.1, several approximate synonyms are associated with this diagnosis code:
- Hot flashes, menopausal, female: This directly refers to one of the most recognizable symptoms of menopause.
- Menopausal flushing: Another term for hot flashes, emphasizing the skin flushing aspect.
- Menopausal symptom: A broader term indicating any symptom experienced during menopause.
- Menopausal symptoms: Plural form, acknowledging the multiple symptoms that can occur.
These synonyms highlight that N95.1 encompasses the common and recognizable symptoms and experiences associated with the menopausal transition in women.
Code History of N95.1
The code history provides a timeline of when N95.1 was introduced and its stability within the ICD-10-CM system:
- 2016 (effective 10/1/2015): N95.1 was introduced as a new code in the ICD-10-CM system. This was the first year of the non-draft ICD-10-CM implementation in the United States.
- 2017-2025 (effective 10/1/2016 – 10/1/2024): Through these years, no changes have been made to the code N95.1. This indicates the code has remained stable and consistently used since its introduction.
This history is useful for understanding the evolution and established nature of diagnosis code N95.1 in medical coding practices.
In conclusion, ICD-10 diagnosis code N95.1 is a specific and billable code for “Menopausal and female climacteric states.” It is used to classify symptoms related to natural menopause in women and is essential for accurate medical coding, billing, and tracking of women’s health conditions. Understanding its application, coding rules, and associated symptoms is crucial for healthcare professionals and those working within the healthcare system.
