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intramural uterine fibroid
Coders: Train Eyes on Fibroid Diagnosis
Figure out why you should report the pathology exam of uterus with leiomyomas as 88307.
Question: When the pathologist diagnoses uterine fibroid tumors, what ICD-9 code should we go for?
Answer: You should select the fibroid diagnosis based on the fibroid's location:
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Also called intracavitary fibroids, Submucous fibroids (218.0, Submucous leiomyoma of uterus) grow from the uterine wall in the direction of the uterine cavity. • Also called interstitial fibroids, Intramural fibroids (218.1, Intramural leiomyoma of uterus) grow within the uterine wall (myometrium). • Also called subperitoneal fibroids, Subserous fibroids (218.2, Subserous leiomyoma of uterus) grow outward from the uterine wall toward the abdominal cavity. • If the doctor doesn't specify the uterine fibroid's location, go for 218.9 (Leiomyoma of uterus, unspecified) as the diagnosis. CPT alert: You should report the pathology exam of uterus with leiomyomas as 88307 (Level V — Surgical pathology, gross and microscopic examination, uterus, with or minus tubes and ovaries, other than neoplastic/prolapse). Even though ICD-9 classifies leiomyoma as a benign neoplasm, a coding convention supported by the American Medical Association (AMA) and the College of American pathologists dictates that you report this condition as 88307, not 88309 (Level VI — Surgical pathology, gross and microscopic examination, suterus, with or without tubes and ovaries, neoplastic). For myomectomy specimens – fibroid tumors that the surgeon removes while leaving the uterus intact – you should bill the pathology exam as 88305 (Level IV — Surgical pathology, gross and microscopic examination, leiomyoma[s], uterine myomectomy — minus uterus). Sign up for newsletters and stay informed.
When the Pathologist diagnoses uterine fibroid tumors you should select the fibroid diagnosis. So Sign up for newsletters and stay informed.
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Uterine fibroids are non-cancerous tumors that develop in the uterus. Fibroids typically affect women over age 30. They are rare in women under 20, and often shrink and cause no symptoms in women who have gone through menopause. The cause of uterine fibroid tumors is unknown. However, fibroid growth seems to depend on the hormone estrogen. As long as a woman with fibroids is menstruating, a fibroid will usually continue to grow.
Detection and Diagnosis
Often the patient will exhibit signs of abnormal bleeding and cramping which can indicate a fibroid. The doctor will perform a pelvic exam and sometimes they can be detected. If the doctor suspects an abnormality, then a vaginal probe ultrasound is performed which will provide invaluable information. In some cases, a magnetic resonance imaging (MRI), is needed to provide more specific information such as size, location, and detailed condition of the uterus.
Location of Fibroids
While most fibroids are not problematic, they can grow and cause heavy and painful menstruation bleeding and abdominal pain. This is mainly caused by size, location and number of fibroids. Depending on the size and location of the fibroid, different treatment options will be available. The different locations are outlined below.
• Intramural Fibroids - Located within the wall of the uterus.
• Subserosal Fibroids - Located underneath the mucosal surface of the uterus.
• Submucosal fibroids - Located in the muscle beneath the endometrium of the uterus.
• Cervical fibroids - Located in the wall of the cervix.
Types of Procedures
There are several different types of treatment procedures available to treat uterine fibroids. Each procedure is different and recovery time depends on the type of procedure. The treatment options are listed below.
Hysterectomy - The entire uterus is removed. It is a surgical procedure where the patient will spend a few days recovering in the hospital.
Myomectomy - There are four different methods used in a myomectomy. They are listed below.
- Abdominal Myomectomy - An abdominal myomectomy is the removal of fibroids through an incision in the abdomen. An abdominal myomectomy is done in a hospital, and women usually can go home within 48 hours of surgery.
- Larposcopic Myomectomy - Removal of fibroids Is done with the aid of a laparoscope. Several small incisions are made instead of one large incision. Fibroids that are attached to the outside of the uterus by a stalk are the easiest to remove laparoscopically.
- Hysteroscopic Myomectomy - Fibroids are removed through the cervix using an instrument called a resectoscope. Procedures using the resectoscope are done in an operating room setting, such as in an outpatient surgery center. This can at times be done under local anesthesia, but most women prefer to be completely asleep with general anesthesia.
- Robotic Myomectomy - This process is done with the aid of a computer and a surgical robot where the ability to operate through small incisions is accomplished with exact precision. When this is used, the surgeon sits at a computer console and looks through a 3-dimensional video camera. The hand movements in the surgeon are duplicated by the robot. This allows the instruments to change angles to allow precise movements.
Endometrial Ablation
Endometrial ablation is a procedure that uses a lighted viewing instrument called a hysteroscope. This procedure will destroy (ablate) the uterine lining, or endometrium. Endometrial ablation can be done by heat, electricity, freezing or microwave. The endometrial heals by scarring, which usually reduces or prevents uterine bleeding. This procedure is done in an outpatient facility under local anesthesia.
This procedure should not be done if you plan to get pregnant in the future. Younger women are less likely than older women to respond to endometrial ablation. After an endometrial ablation, younger women are more likely to continue to have periods and need a repeat procedure.
If you start experiencing abnormal bleeding, pelvic pain, cramping and discomfort, you could have uterine fibroids causing the symptoms. It is best to consult with your primary physician or gynecologist to determine a correct diagnosis and course of treatment.
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