Is N95.1 a billable ICD-10-CM code?

Yes. N95.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does N95.1 sit in the tabular list?

Diseases of the genitourinary system (N00-N99), in the block Noninflammatory disorders of female genital tract (N80-N98).

What cannot be coded together with N95.1?

N95.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

N95.1

N95.1 — Menopausal and female climacteric states

Billable / specific codeICD-10-CM

N95.1 is a billable, specific ICD-10-CM code for menopausal and female climacteric states. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

asymptomatic menopausal state (Z78.0)
symptoms associated with artificial menopause (E89.41)
symptoms associated with premature menopause (E28.310)

Use additional code

Add a secondary code to capture the detail described below.

code for associated symptoms

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Symptoms such as flushing, sleeplessness, headache, lack of concentration, associated with natural (age-related) menopause

Risk adjustment

N95.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

N95.1 is named in 3 Medicare coverage policies — 3 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52421Billing and Coding: Ibandronate Sodium
A59040Billing and Coding: Bone Mass Measurement
A59040Billing and Coding: Bone Mass Measurement

How N95.1 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to N95.1.

Climacteric›symptoms(female)
Flushing›menopausal
Hot flashes›menopausal
Menopause, menopausal›symptomatic
Sleeplessness›menopausal
Symptoms NEC›menopausal
Vertigo›menopausal
State›climacteric, female›symptomatic
State›menopausal›symptomatic

Related codes at this level

Codes that share N95. If N95.1 is not quite right, the correct code is usually one of these.

Questions about N95.1

Is N95.1 a billable ICD-10-CM code?: Yes. N95.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does N95.1 sit in the tabular list?: Diseases of the genitourinary system (N00-N99), in the block Noninflammatory disorders of female genital tract (N80-N98).
What cannot be coded together with N95.1?: N95.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.