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Postmenopausal bleeding vs. bleeding in someone that's postmenopausal

  1. #1
    Stuart, Florida
    Question Postmenopausal bleeding vs. bleeding in someone that's postmenopausal
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    I have a patient that the doctor documented "Postmenopausal bleeding secondary to uterine fibroids, being followed by gynecologist" for.

    I feel like 627.1 is not the correct code selection to make for this case because, though 627.1 is for postmenopausal bleeding, the bleeding is being caused by the fibroids. I feel like 'postmenopausal' is more of a side note to "bleeding secondary to uterine fibroids".

    ANYWAY, I was wondering if 626.6 might be more appropriate for this case. I pulled up this information about code 626.6, which is for Metrorrhagia, but I'm still not 100% certain.

    Agree? Disagree? Does anyone have a better suggestion? Any help would be greatly appreciated! Thank you!
    Vanessa Mier, CPC

  2. #2
    Charleston, WV
    If I were going to use a 626 code, I would go with 626.9 because the bleeding is unrelated to mentruation and all of the other 626 codes that almost fit mention menstruation.

    If I were coding it, though, i believe I would not code the bleeding because it is a symptom of the fibroids. I think that's the route I would take but it would depend on the documentation.

  3. Default
    Kindly check the other thread where I have posted the reply.
    No the code 626 does not apply to post menopausal; even for menopausal and premenopausal bleeding
    This can be validated by the exculdes notes just below the main categoryof 626.
    When menopaused women gets bleeding, it is authentically Postmenopausal bleeding episode or disorder. In her the uterine fibroid may be a cause. Any post menoppausal bleeding condition has be taken seriously and malignancy should be thought of to exclude for her- malignancy Cx, uterine , or even ovarian or vagina or vulva
    Generally,fibroid uterus rarely goes for mailgnancy but can though in postmenopausal. Fibroids not necessarily have to bleed.
    And fibroid is not the only and exclusive reason for PMB. PMB is a distinct entity of its own.
    How would you avoid or delete 627.1 from the scenerio?
    I would emphasis on 627.1 as the diagnosis at the first instance and ofcourse give supporting diagnosis of uterine Fibroid.
    Moreover the encounter was PMB, not the fibroid

    You can check with your physician which one to be prim listed as s/he pleases to.
    Last edited by preserene; 10-21-2010 at 03:59 PM.

  4. #4
    Charleston, WV
    I don't believe anyone suggested that fibroids are the only source of PMB or that all fibroids must necessarily bleed. However, in this case those are the facts presented. When coding, you must use the documentation you have for THIS CASE. The fact that fibroids can become malignant is irrelevant to the coder in this case. The 626 series is not only disorders of menstruation but is also "other abnormal bleeding from female genital tract." I agree that 626.6 is inappropriate but if the bleeding is to be coded at all, 626.9 is more appropriate than 627.1 in THIS CASE. Folowing your logic, bleeding due to an injury would have to be coded 627.1. Yes, PMB is a distinct diagnosis but by definition can also be a symptom of another condition such as vaginal atrophy (627.3), endmetrial polyps (621.0) or uterine tumors (236.3). In my opinion, just as you don't code abdominal pain with appendicitis because it is a symptom of appendicitis, you should not code bleeding IN THIS CASE because it is a stated as a symptom of the fibroids. Let me reiterate: The documentation states that the bleeding is caused by the fibroids.

  5. Default
    Gost Thank you.Your logic is wrong and I don’t have to take it in the way you argue and I know I don’t have to.
    It is a PMB with Fibroid .Well, take the whole of my posting, this particular thread to the same doctor and clarify with her/him ,after reading mine, what he or s/he says that is the final because it is her/his case..
    Those conditions i have already given in the other thread.
    The malignancy part I just mentioned as its chances of occurrence an dbecuase a case with PMB when bleeds is amatter of concern and this case in particular. You seem to take a debate on this.
    I don’t want to go for that and I know where I stand especially my ObGyn and its realted subject.

    I vehemently reinstate that this is PMB code with addition of fibriod code and not in the category of 626.9 too.
    626 though with the wording of female genital tract in it, The 4th and 5th digit do relate to menstruating women and not for post menoapusal women; Please look into the EXCLUSION NOTES OF 626 Starting notes- it does not even include the menopausal and premenopausal (ie all perimenopausal) candidiates too.
    Last edited by preserene; 10-22-2010 at 10:57 AM. Reason: ,

  6. #6
    Stuart, Florida
    First, I wanted to say that everyone has a right to post their suggestions and opinions. There is no reason to get nasty with eachother. There is no reason to post that someone is wrong and that you don't have to listen to their opinion. Show some tact. There is a proper way to tell someone you disagree with them. I know we are all passionate about what we do and what our knowledge of our profession is. I don't believe there is a single person out there that knows absolutely everything though.

    Ok so, I want to just go ahead and follow up with this thread that I posted yesterday. I wanted to say thank you for your suggestions. I did some more research on the subject of exactly what metrorrhagia is and includes. Like I said yesterday, I didn't think that code 626.6 fit either because I felt that these codes were solely for premenopausal women. From the researching that I did, I came to the understanding that postmenopausal bleeding, regardless of the cause, is postmenopausal bleeding. I'm going to go ahead and post the info I got just for the added knowledge.

    Metrorrhagia Types
    Metrorrhagia refers to uterine bleeding that is not related to menstruation, a normal uterine bleeding every 21 to 35 days which is a result of the shedding of the endometrium, the inner lining of the uterus. Any bleeding outside the normal menstruation period is a type of abnormal vaginal bleeding and a sign that something is wrong.

    Metrorrhagia, sometimes referred as intermenstrual bleeding can be a sign of various disorders including an underlying medical condition but it does not necessarily indicates a serious health problem although it can be also a symptom of a cancer. Abnormal uterine bleeding is most often a result of hormonal imbalances which may cause only spotting or heavy bleeding between the menstrual periods. It is most common in girls who just started menstruating and in women in perimenopause or before menopause. Hormonal imbalances may also result in menometrorrhagia, a type of metrorrhagia which is characterized by prolonged or severe uterine bleeding that is not related to menstruation as well as in dysfunctional uterine bleeding. This condition is characterized by abnormal uterine bleeding and is commonly related to hormonal changes although the exact causes often remain unknown.

    Dysfunctional uterine bleeding (DUB) is categorized into two types, known as the ovulatory dysfunctional uterine bleeding and anovulatory dysfunctional uterine bleeding. The first type of DUB occurs in women who are ovulating but the anovulatory DUB is responsible for approximately 90% of DUB. Anovulatory DUB is characterized by inappropriately developed and released egg resulting in excessive growth of the endometrium, an inner lining of the uterus. This type of DUB typically results in delayed periods which are typically heavy and prolonged. It can be caused by a large number of factors but the exact cause often remains unknown.

    Very common type of metrorrhagia is also the so-called post coital bleeding which occurs after sexual intercourse but may also occur spontaneously. Another type of metrorrhagia is also the so-called mid cycle spotting. It usually occurs ten to fifteen days after the last menstruation period and is experienced by approximately 30% of girls and women at certain point of life. Mid cycle spotting usually is not indicating a serious underlying medical condition and is most often caused by hormonal imbalances. Intermenstrual bleeding and acute bleeding are sometimes used as a synonym for mid cycle spotting but both terms may also refer to uterine bleeding of different amounts between the normal menstrual periods. Metrorrhagia that occurs in postmenopausal women is known as postmenopausal bleeding.

    In some cases, metrorrhagia is a side effect of certain medications but can be also a result of a withdrawal of oral contraceptives or hormone therapy. This type of metrorrhagia is known as a withdrawal bleeding.
    So from that, I gathered that I should be using 627.1 IF I use a code at all. With this new information, my decision is to not code it. I suppose you can say I agree with you both. Thanks for your help!
    Vanessa Mier, CPC

  7. #7
    Charleston, WV
    Thanks for posting that info. I was not aware that metrorrhagia was defined as unrelated to menstruation. I've learned something from you twice in one week!

  8. Default
    Vanissa, good. The meaning here, of unrelated to menstruation: is that the bleeding occuring has no relation to the regular menstrual cyclical event of a menstruating age women.
    No gynocologist or Gynocological Text book terms PMB so. I have gone through many of those books like Jeffcoat or Deuhaust and many other authenticated text Books ; none of them refer PMB as Menorrhagia or metrorrhagia or monometrorrhgia.
    PMB can be one group in DUB; even a vaginal bleeding in childhood can be categorized under DUB, meaning DUB includes all age group an deven anemia causing bleeding is grouped under DUB.
    But PMB or a child having vaginal bleeding at the age of 4, or before menorche, is not termed as menorrhagia or metro in its true sense, Because to give that terminology to PMB/ child's vaginal bleeding, the stage of menstruation is already passed/ or not yet attained menarche
    Well, that is the end of my say. I dont want to go with this anymore. .
    You can very well clarify with your Leading Gynecologists too, atleast for the sake of knowing the facts as facts. Also please be back when you get paid with the payers with the ICD code, no matter what. O.K Vaniessa?!
    Over and above, coming back to coding Manual, It clearly states that as I said it is under EXCLUSION from 626 series. The manual is the gold standard for us what ever said and done .It is like a cheese on our hand!
    Well, let me go with Cheerio!

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