Pediatric Coding Alert

Frequently an adolescent will ask her pediatrician for advice about menstruation. According to our sources, these patients will most commonly be concerned about cramps. If there is no pathology, what diagnosis code can be used to maximize reimbursement?

If menstrual concerns with no disease are the only reason for the visit, then you will have to focus on the reason the patient came to see you, explains Kathy Fitzjarrell, office manager for Toshio Yamauchi, MD, FAAP, of Sugarland, TX. If you cant come up with an illness, you go with signs and symptoms, she says. Lets say the patient is cramping, and worried about it, but there are no real problems. Then you should use 625.3, recommends the office manager. This is for dysmenorrhea, or painful menstruation.

This is a true diagnosis code, not just a signs and symptoms code. But just using the symptom is fine, as long as it isnt a mental disorder, says Fitzjarrell. Insurance carriers may not pay providers for mental diagnoses unless they are mental health providers. That means you should avoid 306.52 , which is psychogenic dysmenorrhea.

Menstrual-related diagnosis codes sometimes dont make it onto pediatric superbills, notes Cathy Williams, billing supervisor for Lehigh Valley Pediatric Associates, a five-pediatrician, two-nurse practitioner practice in Allentown, PA. But if the code isnt on the superbill, our providers can come to me with the question, she says, adding that 625.3 is clearly the code to use for cramps.

There are other diagnosis codes which could be useful for a teen concerned about menstruation as well. These are: 625.4 (premenstrual tension syndromes), 626.1 (scanty or infrequent menstruation), 626.2 (excessive or frequent menstruation), and 626.3 (puberty bleeding).

Note: 626.2 excludes bleeding that may be associated with the onset of menstruation. This is properly coded using 626.3.