Find comprehensive information on heavy menstrual bleeding, also known as menorrhagia. This resource covers diagnosis, clinical documentation, ICD-10 codes (N92.0, N92.1), medical coding for heavy periods, and abnormal uterine bleeding management. Learn about related terms like hypermenorrhea, menometrorrhagia, and dysfunctional uterine bleeding for accurate healthcare documentation and coding. Explore causes, symptoms, and treatment options for heavy periods.
Also known as
Other specified abnormal uterine bleeding
Includes heavy menstrual bleeding (menorrhagia).
Excessive and frequent menstruation
Covers both increased frequency and flow of menses.
Other specified menstrual disorders
Can be used for heavy periods not otherwise specified.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the heavy menstrual bleeding regular?
Yes
Is there an underlying cause?
No
Is it intermenstrual bleeding?
When to use each related code
| Description |
|---|
| Heavy menstrual bleeding |
| Menorrhagia (heavy periods) |
| Dysfunctional uterine bleeding (DUB) |
Coding N92.0 without specifying cause (e.g., fibroids, adenomyosis) leads to lower reimbursement and inaccurate clinical data.
Overlooking Dysfunctional Uterine Bleeding (DUB) as a cause can impact quality metrics and patient management.
Incorrectly coding Abnormal Uterine Bleeding (AUB) variations can trigger audits and claim denials.
Q: What are the most effective diagnostic approaches for evaluating menorrhagia in adolescents, considering both common and less common causes?
A: Diagnosing the underlying cause of heavy menstrual bleeding (menorrhagia) in adolescents requires a systematic approach. Begin with a detailed history focusing on menstrual cycle characteristics (frequency, duration, flow), associated symptoms (pain, fatigue, clotting), and family history of bleeding disorders. A physical examination, including pelvic exam if clinically indicated, is essential to rule out structural abnormalities. Initial laboratory tests should include a complete blood count (CBC) to assess for anemia, coagulation studies (PT/PTT/INR) to identify potential bleeding disorders like von Willebrand disease, and thyroid function tests. Consider iron studies (ferritin, iron saturation) if anemia is suspected. If initial investigations are inconclusive, further evaluation may include hormonal assessments (e.g., FSH, LH, estradiol, prolactin), pelvic ultrasound to assess for uterine fibroids or polyps, and potentially endometrial biopsy if indicated based on age and risk factors. Explore how a multidisciplinary approach involving hematologists, gynecologists, and endocrinologists can provide comprehensive care for complex cases. Consider implementing standardized protocols for menorrhagia evaluation in adolescents to ensure consistent and evidence-based management.
Q: How can I differentiate between primary and secondary dysmenorrhea when evaluating a patient with heavy menstrual bleeding and pelvic pain, and what are the best practice management strategies for each?
A: Differentiating between primary and secondary dysmenorrhea in patients presenting with heavy menstrual bleeding (menorrhagia) and pelvic pain requires careful clinical assessment. Primary dysmenorrhea is characterized by cramping pain during menstruation in the absence of any underlying pelvic pathology. Secondary dysmenorrhea, however, is caused by an underlying condition such as endometriosis, adenomyosis, pelvic inflammatory disease (PID), or uterine fibroids. Key distinguishing features include the timing and nature of the pain. Primary dysmenorrhea typically starts within a few years of menarche, occurs only during menstruation, and is characterized by cramping lower abdominal pain. Secondary dysmenorrhea may start later in life, be present outside of menses, and involve chronic pelvic pain. Management of primary dysmenorrhea includes first-line therapy with NSAIDs and hormonal contraceptives. Lifestyle modifications, such as regular exercise and stress reduction techniques, may also be beneficial. For secondary dysmenorrhea, managing the underlying cause is crucial. This may involve surgical interventions (e.g., laparoscopy for endometriosis), medical therapies (e.g., GnRH agonists for fibroids), or antibiotics for PID. Learn more about the role of imaging modalities, such as ultrasound and MRI, in diagnosing secondary dysmenorrhea and guiding treatment decisions.
Patient presents with complaints of menorrhagia, clinically manifesting as heavy menstrual bleeding. She reports prolonged menstrual flow lasting greater than seven days (hypermenorrhea), soaking through one or more pads or tampons every hour for several hours, passing large blood clots, and experiencing symptoms consistent with anemia such as fatigue, shortness of breath, and pallor. Menstrual cycle regularity is noted to be variable, with cycle length ranging from 21 to 35 days. Differential diagnosis includes dysfunctional uterine bleeding, uterine fibroids, adenomyosis, endometrial polyps, bleeding disorders, and hormonal imbalances. Pelvic examination revealed a normal-sized, non-tender uterus. Transvaginal ultrasound was performed to assess for structural abnormalities. Laboratory evaluation included a complete blood count to assess for anemia secondary to heavy menstrual bleeding, coagulation studies to rule out bleeding disorders, and thyroid function tests. Initial management includes iron supplementation for anemia and discussion of medical management options for heavy periods such as hormonal contraceptives including combined oral contraceptives, progestin-only pills, hormonal IUDs, and tranexamic acid. Patient education provided regarding the importance of follow-up and potential surgical interventions such as endometrial ablation or hysterectomy if medical management proves ineffective. Patient was scheduled for follow-up in three months to reassess menstrual flow and symptom improvement. ICD-10 code N28.0, Menorrhagia, was assigned.