2025 ICD-10-CM code N97.9
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the genitourinary system - Female infertility Chapter 17: Diseases of the genitourinary system Feed
Female infertility, unspecified.
Medical necessity for this code is established by the documentation of at least 12 months of unsuccessful attempts to conceive naturally (or less in certain clinical circumstances), combined with a comprehensive evaluation to rule out identifiable causes.The extensive workup to determine the cause of infertility warrants the application of this code when no definitive diagnosis can be reached.
The clinical responsibility for this code involves a comprehensive evaluation of the female reproductive system, including hormonal assessments, imaging studies (e.g., ultrasound), and potentially specialized testing to identify potential causes of infertility.Treatment may include medication, surgery, or assisted reproductive technologies (ART).
In simple words: This code is used when a woman hasn't been able to get pregnant after trying for at least a year, and doctors can't find a specific reason why.
This code signifies female infertility where the specific cause is unknown or cannot be determined.It encompasses cases of diminished or absent ability to conceive after at least one year of trying, or repeated miscarriages, where underlying etiologies such as anovulation, tubal issues, uterine problems, cervical factors, male factors, or other specified reasons have been ruled out or remain unidentified.
Example 1: A 32-year-old woman has been trying to conceive for 18 months without success.Extensive testing, including hormone analysis, hysterosalpingography, and semen analysis of her partner, reveals no clear cause for infertility.Code N97.9 is assigned., A 38-year-old woman experiences recurrent miscarriages without any identified underlying abnormalities in her uterus, hormones, or chromosomes.Despite thorough investigation, the cause of her infertility remains unclear. Code N97.9 is assigned., A 28-year-old woman presents with primary infertility (never pregnant).Initial testing reveals normal ovulation and patent fallopian tubes.Further investigations are inconclusive, and Code N97.9 is used for reporting.
Detailed history of attempts to conceive, including frequency and duration. Results of relevant investigations such as hormonal assays (FSH, LH, estradiol, progesterone, TSH, prolactin), ultrasound imaging of the pelvic organs, hysterosalpingography, semen analysis (if applicable), and any other specialized tests conducted.Documentation should reflect the comprehensive evaluation undertaken and the lack of a definitive diagnosis.Notes on the patient's medical history, lifestyle factors, and relevant family history should be included.
** Consider using additional codes to describe any comorbidities or related conditions identified during the evaluation, even if the primary diagnosis remains unspecified infertility.
- Payment Status: Active
- Specialties:Obstetrics and Gynecology, Reproductive Endocrinology and Infertility
- Place of Service:Office, Outpatient Hospital, Fertility Clinic