Today we're going to talk about the chapter
for the Female Genital System. This is a
slide that is kind of busy, but as most
of you probably know the female plumbing
is quite complex. God in his wisdom has made
so many parts of our body to allow us to
reproduce and it is very complicated. The
textbook chooses not to focus on any of
the maternity codes or the delivery
codes so i will just barely touch on
those in my lecture but just suffice it
to say that the best way I think to code
is to get very accustomed to navigating
the code book the way I've shown you
from the Table of Contents. I'll go over
that again today just to be sure you
understand the index is helpful most of
the time but once you really know your
code book, there is a very good chance you can
just code directly from the code book.
Bypass the Index and go straight to that
section within the code book that would
answer your question. One thing I want to
make a point of emphasizing is the
difference between a hysteroscopy and a
hysterectomy. Obviously the hysteroscopy
is the scope that allows the physician
to look inside the uterus and it is not
uncommon for a D&C (Dilation and Curettage) procedure to be performed
through the hysteroscopy. We'll talk
about that a little bit later too. There
are three different kinds of
hysterectomies that are have codes
assigned to them. One is the
"supracervical" meaning "above the cervix"
"vaginal" where everything (uterus, fallopian tubes and ovaries) comes out
through the vagina and then the
total hysterectomy where the uterus and
cervix are both removed through the
scope. I can't tell you why the weight of
the uterus is significant. I looked
around for some information on that and I
couldn't find anything that really
answered my question. So just be aware
that the way the uterus does come into
play here.
Then there's the traditional
excisional approach where the incision
is made through the front wall of the
abdomen. As I mentioned earlier, I'm just
going to briefly touch on these Maternity
Care and Delivery codes for Physician
services. Recognize that some CPT codes
address global care and some report only
a portion of the Maternity care, Delivery
care. For example, there's two given here
where CPT code 59425
would be for antepartum care, four to six
visits and 59510 would be for a
physician who was doing the care for the
patient, for a Cesarean delivery from
start to finish. Again, going back to
reading those two descriptions very
carefully. Now let's talk a bit about the
global service package, the way that that
is reimbursed by the insurance company. I
have here, in bullet points, those
parts of a global service package for
the antepartum, which is the care going
up to the delivery. Then here's your
delivery codes. Here's these
services under the global service
package for delivery services and for
postpartum. Even though the code book has
these codes available, the textbook
barely mentioned them and does not have
any exercises pertaining to them so I
won't spend a lot of time on those. Let's
look through some of our Exercises 4.35
#2, the laparoscopic fulguration
of fallopian tubes. Here's your
code and the pathway in the index. You
notice that another word for fallopian
tubes are the "oviducts".
Here is a D&C performed for a patient
with a diagnosis of incomplete abortion
and the anatomy fact to remember is the
part of the female genital system that
is applicable here is the corpus uteri
when you're looking at the different
subsections within the female genital
system. The corpus uteri is the main body
of the uterus above the constriction
that's behind the cervix and below the
opening of the fallopian tubes. So if you
were going to do a D&C, you would be
doing that on the corpus uteri.
For a review of what a D&C is,
the D&C is the dilation where the cervix
is dilated and a special instrument is
inserted to scrape the uterine lining.
That is done during or after a
miscarriage or an abortion or to remove
small pieces of placenta after
childbirth. They commonly will do a D&C
when a patient just keeps bleeding and
they are trying to figure out why. They'll go
in and do the D&C and oftentimes that
takes care of it. The D&C can also be
used to diagnose or treat growths such
as fibroids, polyps or uterine cancer,
different things like that. So back to
our question in the index the dilation
and curettage would be the main term and
corpus uteri would be the part of
the body that is having a procedure
performed on it. (4.35 #6) Abdominal hysterectomy
with a salpingo-oophorectomy. The procedure
fact to remember here is that the
removal of both the ovary and the
fallopian tube is called a salpingo-oophorectomy.
If its unilateral, it is
referred to as "USO"for unilateral salpingo-oophorectomy
and when both ovaries and
both fallopian tubes are removed that is
called a bilateral salpingo-oophorectomy or
BSO.
There would be a code. Obviously, you
didn't need to know all of that to be
able to find that code but I think it is
important because it's possible that you
would have a procedure that would not be
a hysterectomy but would be strictly
the salpingo-oophorectomy.
The operative report that's given (#2)
diagnostic hysteroscopy with a
fractional dilation and curettage. When
you read this code description, you
notice it states with or without the D&C,
so you would not code the D&C in
addition to the hysteroscopy. There's
your codes. You're coding "with biopsy"
because it says "diagnostic hysteroscopy"
implying the biopsy ("diagnostic" implies "biopsy"). Exercise 4.37 #2
the vulvectomy partial removal of
skin and superficial sub-cutaneous tissue. As a
reminder, there are definitions in front
of this section of the code book so
let's look at that so we can be sure
we're all on the same page. Here you
can see, under this part of the
the subsection, Vulva, Perineum and
Introitus. Here's the definitions for
when you have an Incision, Destruction or
excision exactly what you're doing, how
much is involved is defined here in
these definitions. As I was mentioning
earlier about reminding you of the
sections of the code book and the
procedures under it in red (main heading), these are the
subsections of the female genital system
and then in blue (subheading) the different
procedures that would follow under each
of those subsections. So it is possible
to find codes using your codebook and
never go to your index. I encourage
you to try that sometimes. I think if you
get very familiar with the CPT code book
you'll be able to do that without too
much trouble.
Here are the answers.
Here you see (4.37 #4) the patient desires sterilization and
a surgeon performs a banding and in this
example, taken from the textbook, the
surgical approach is not given and the
selection of a code would depend upon
that approach. So if we assume a
vaginal approach ,we would assigned 58615
but in the real world, you would have
an operative report that you would be
coding from and there would be no
question as to the approach.
Ex. 4.27 #6 Here's a
biopsy of two lesions from two different
parts of the female genital system, one
of which requires a suture closure. If
you read the code descriptions for these
two codes, you see the biopsy of the vagina
includes a suture closure. So you would
not be coding the repair in addition to
the biopsy. It is included in that code.
(Ex. 4.27 #8) A hysteroscopy with removal of
fibroids, a fact to remember, another word
for fibroid is "leiomyomata" and there is
your answer.
(Ex. 4.27 #10) Endometrial cryoablation with ultrasound guidance
and there is the answer. If you have any
questions about the female genital
system, please post your question on the
discussion board along with the index
path you used to try and find a code.
I will attempt to help you. Thanks so
much and have a good day.
you