2025 ICD-10-CM code Z79.890
(Active) Effective Date: N/A Revision Date: N/A Factors influencing health status and contact with health services - Persons with potential health hazards related to family and personal history and certain conditions influencing health status Chapter 21: Factors influencing health status and contact with health services Feed
Hormone replacement therapy.
Modifiers may be applicable depending on the specific circumstances of service. Consult the appropriate payer guidelines and medical coding manuals.
Medical necessity for hormone replacement therapy is established based on the patient's specific clinical presentation, including symptoms, medical history, risk factors for conditions such as osteoporosis and cardiovascular disease, and the potential benefits and risks of the therapy. This determination should be documented clearly in the medical record.
The clinical responsibility lies with the healthcare professional prescribing and managing the hormone replacement therapy. This includes monitoring the patient's response to treatment, adjusting dosages as needed, and addressing any adverse effects.Regular check-ups and blood tests may be required.
In simple words: This code is for hormone replacement therapy, which is a long-term treatment using hormones to prevent certain conditions. This code doesn't apply if someone is misusing or is addicted to hormones, or if the hormones are causing problems during pregnancy or after childbirth.
This ICD-10-CM code signifies hormone replacement therapy, a long-term medication regimen used for prophylactic purposes.It's crucial to note that this code excludes drug abuse, dependence, and drug use complications during pregnancy, childbirth, or the puerperium.Any related therapeutic drug level monitoring should be coded separately using the appropriate code.
Example 1: A 55-year-old postmenopausal woman presents for a routine follow-up appointment for hormone replacement therapy prescribed to manage vasomotor symptoms (hot flashes) and prevent osteoporosis.The physician reviews her medication regimen, conducts a physical exam, and orders blood tests to monitor hormone levels and bone density., A 60-year-old woman experiencing severe menopausal symptoms, including hot flashes, night sweats, and vaginal dryness, initiates hormone replacement therapy. The physician explains the benefits, risks, and long-term implications of the therapy. Blood work is ordered to assess hormone levels and rule out any contraindications., A transgender woman undergoing hormone replacement therapy as part of her gender transition care visits her endocrinologist for regular monitoring of hormone levels.Her blood work is analyzed to assess the efficacy of the therapy and to make necessary adjustments to the dosage or type of hormones.
* Thorough patient history including age, sex, menopausal status (if applicable), reasons for initiating hormone replacement therapy (e.g., vasomotor symptoms, osteoporosis prevention, gender transition), relevant past medical history.* Detailed physical examination findings.* Results of laboratory tests, including hormone levels, bone density, and any other relevant tests.* Medication reconciliation to identify any potential drug interactions.* Documentation of informed consent obtained from the patient, including discussion of risks, benefits, and alternatives to hormone replacement therapy.* Documentation of the treatment plan, including the type and dosage of hormones prescribed, frequency of follow-up appointments, and methods of monitoring treatment efficacy and safety.
** Always ensure proper documentation to support the medical necessity of hormone replacement therapy.This is crucial for accurate coding and successful reimbursement.
- Payment Status: Active
- Modifier TC rule: Not applicable, this is a diagnosis code, not a procedural code.
- Specialties:Endocrinology, Gynecology, Family Medicine
- Place of Service:Office, Hospital, Outpatient clinic