2025 ICD-10-CM code N97
Female infertility. Inability to achieve pregnancy.
Medical necessity for the evaluation and treatment of infertility is established by the documented inability to conceive after a reasonable period of time, typically 1 year of regular unprotected intercourse for women under 35, or after 6 months for women over 35. The specific diagnostic tests and treatments must be medically appropriate for the patient's condition and supported by clinical findings.
Diagnosis and management of female infertility falls under specialties like reproductive endocrinology, obstetrics, and gynecology.The clinician is responsible for conducting a thorough evaluation including medical history, physical examination, and diagnostic testing to identify the cause of infertility.Treatment options and ongoing monitoring are also part of the clinician's responsibilities.
In simple words: This code represents a woman's inability to get pregnant.
Diminished or absent ability of a female to achieve conception. Includes: inability to achieve a pregnancy; sterility, female NOS. Excludes2: female infertility associated with hypopituitarism (E23.0), Stein-Leventhal syndrome (E28.2), incompetence of cervix uteri (N88.3)
Example 1: A 35-year-old female presents with a history of 1 year of unprotected intercourse with her partner without achieving pregnancy.After initial evaluation, including semen analysis for the partner, the physician diagnoses the patient with female infertility (N97)., A 28-year-old woman with a history of irregular periods is unable to conceive after 6 months of trying. Diagnostic tests reveal anovulation, and she is diagnosed with female infertility associated with anovulation (N97.0)., A 40-year-old female undergoes an infertility workup that reveals bilateral tubal occlusion. The physician diagnoses the patient with female infertility associated with tubal factors (N97.1).
Documentation should include a detailed medical history, including menstrual history, previous pregnancies, and any relevant medical conditions. Physical examination findings, results of diagnostic tests such as hormone levels, hysterosalpingogram (HSG), and pelvic ultrasound should also be documented.The duration of infertility and any treatments attempted should also be noted.
** Excludes conditions that can cause infertility but are coded elsewhere: hypopituitarism (E23.0), Stein-Leventhal syndrome (E28.2), incompetent cervix uteri (N88.3).N97 is a billable ICD-10 code.
- Payment Status: Active
- Specialties:Reproductive Endocrinology, Obstetrics and Gynecology, Urology (for male infertility)
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital (if surgery is performed for infertility treatment)