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Menses suppression in CP female

  1. Default
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    I was never ever against the V code. It has its validation and merits here.You go thro' my first few posts you would understand that. My stand is for the diagnosis of suppression of Menstruation. Well the patient encounter to the OBGYN is for the very purpose of suppression of menses; the CP diagnosis and other stuff are secondary.
    Here the problem is the menstruation which is an unwanted condition ,meaning, the very normality is an abnormal phenomenon for this particular patient's wellbeing and it is considered abnormal to have menstruation which needs to be reduced in frequency or abolished for a while. This is the condition which needed to be addressed.
    Well, I don't want to keep on placing what is relevant there from my many years of practice with the treatment of suppression of menstruation with multitudes of patient and your stand seems to be strange and unacceptable in the realm of clinical diagnosis and coding aspects where in both their theory fits well with mine. Since i have experience in both these arena, I came a long way only to be a jerk. It is high time I stop with my decision as the right one whether I am right or wrong on others view. Bye

  2. #12
    Columbia, MO
    Sorry Preserene but I have to agree with the others on this. The 626.8 is absolutely an incorrect choice in this case. The main category heading which must be a part of the 626.8 code states this is a disorder or menstruation and other abnormal bleeding. So when 626.8 states suppression of menstruation as a definiton it is meant supression as a disorder of the patient and not a normal patient that wishes to have a suppression of menstruation due to debilitation. This code is also in the chapter for diseases and disorders of the genitourinary system, which this patient does not have. Also the CDC creates ICD-9 codes not the AMA. No one is questioning your experience or expertise. It is just a misinterpretationof the codes. We need to remember that this is the patient's dx and we must be absolutely correct and not read too much into what we are seeing either in the physician notes or in the ICD-9 book. The CDC has put these codes in the book in a specific fashion for specific purposes. While your rational is quite well thought out, the code simple does not work the way you would like it too. The patient has no complain nor an identified genitourinary illness by the physician, and therefore we cannot use a code from this chapter. I hope this will help everyone.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    "Disorders of Menstruation; 626.8 Others- MENSTRUATION: SUPPRESSION OF,"
    well for general population what you discuss very much applicable.I agree.
    We do not have a definitive code for suppression of menstruation with the term "for normal menstruation;

    But scenario like this case:
    It comes to my mind this Phrase" One man’s food is another man’s poison" at times. Here is a patient for whom the disorder of menstruation is the "normal-occuring cyclical menstruation".
    Here is a patient who has made an encounter to the OBGYN specialist for only suppression of Menstruation. What is a normal functional phenomenon for an ordinary person, has become dysfunctional/or disorder for this lady and that is the whole lot of misery for her. What is 'NORMAL' for general population IS phenomenally an abnormal condition at this juncture and the physician has to address to THIS ABNORMALITY IN HER TO WHAT IS SEEMINGLY NORMAL FOR HER and give treatment for her. That menstrual order is to be turned to what is normal for her deceased situation.
    Though what you say is generally applicable and true to its sense for a general population, this case has to be individualized and “her abnormality” of menstrual order is to be managed with the treatment to correct to "her" normalcy, comfort and ease.
    So take the diagnosis part of "suppression of menstruation" which is to phenomenonly stop /restrict menstruation-irrespective of normal menstruation, abnormal menstruation or dysfunctional menstruation. When a client comes/encounters for that diagnosis, the existing menstruation in her is an abnormal,or dysfunctional condition FOR HER and we address that dysfunction to what is right to be HER FUNCTIONAL ,normalcy and treatment to make her comfortable and have a secured life.
    On that perspectives, I place the encounter, what is deemed to be a disorder and dysfunctional "for her" into a management modality and the code 636.8 as a valid one which is the main focus/reason for encounter(suppression of menstruation), though the V code which is to be first listed as per its merits and guidelines of ICD-9.
    It is only for a debate in the forum I take it; where else we have liberty to do?; not for who win or who loose. May be I am wrong. would I be stripped off my CPC or my professional postgraduation? I do not want to enter into arguement anymore.
    Thanks for all your postings.
    Last edited by preserene; 12-17-2010 at 01:49 AM.

  4. #14
    Columbia, MO
    What you are talking about is more a mental state of mind rather than a disease/disorder of the genitourinary system. She is (or caregiver) choosing a lifestyle that maybe you think of abnormal given the general population but for her is perfectly rational and normal. We cannot assign a disease code based on what we find personally reprehensible or abnormal given what we feel is normal. As far as can you be stripped of credentials.. I do not know. What I do know is you are suggesting assignment of a diagosis that has not been rendered by the physician nor that the patient has. So you are in fact communicating a diagnosis that the patient does not have. You are the coder and not the physician so we can never assign a diagnosis that is not rendered by the physician. and we cannot assign our own definitions to the ICD-9 codes. But assigning diagnosis incorrectly can have portential harm to the patient down the road.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    628.8 other -
    suppression of
    This term "menstruation" usually is used for defining the normal menstrual cycle.
    Can't we construde it as applicable to suppression of menstruation, no matter what the cause is. the description goes for suppression of menstruation.
    I am not happy with the statement saying that my diagnosis is self given; this is the diagnosis given by the OBGYN. OBGYN do not have to give a primary diagnosis of CP or other medical condition as the primary diagnosis in this particular encounter for suppression of menstruation.
    There are numerous other conditions for eg, endometriosis where in the physician finds medical necessity for inducing an artificial menopause, in other words suppression of Menstruation for a short while. There are variety of drugs being used for this.
    Where do you place them for their encounter for Suppression of Menstruation for certain period.
    There are much more conditions like that where in the Suppression is not for contraception.
    I feel that it is reasonable that this subcategory Code 626.8 or 626.9 could be meant for them too. Most of the abnormal uterine bleeding conditions have their own terminology and treatment modalities associated with it.
    Suppression of menstruation is the general terminology in vogue by the Physicians for creating cessation of period/creating an artificial menopause like condition
    and I feel that this code description of Menstruation: Suppression of , could hold good for any condition which necessitates a medical necessity of creating a suppression of Menstruation irrespective-CP, endometriosis and many other conditions.
    Please do not make statement that I give a wrong diagnosis where in it was the diagnosis by the OBGYN "Suppression of Menstruation.
    I do not have to be a physician to write my opinion , though one can be both at the same time!!!!!
    Cheerio Michellede , I do respect that you are an expert and with superb coding experience and knowledge

  6. #16
    Stuart, Florida
    You're not wrong, Brandi. Preserene doesn't like being told that someone doesn't agree with him. No matter how many years experience someone has, it does not mean that they are above misunderstanding. I, just for the heck of it, did some research on this subject. I went above that and took a print out of this entire thread to the OB/GYN that works with my office. And for YOUR kind information, he disagrees with you. He's the one that gave me a lot of the information that I posted above, which I then found plenty, just searching online, backing it up. I'm sure that, by now, debrowne has chosen what code they are going with, regardless of what it is. What I constantly find disturbing about posts in which preserene gets involved is the fact that he finds it so difficult to agree to disagree with someone and the attitude that radiates from his comments. There is, at the very least, a slight language issue. I can tell that he is an intelligent person but sometimes I feel that something is getting lost in translation. Plain and simple, you cannot force someone to agree with you. When someone posts a question, I'm sure they appreciate any helpful information that can be given to them. I just know that I'm tired of seeing the elitist attitude. Although your input is always welcomed, you're not always right.
    Vanessa Mier, CPC

  7. #17
    Columbia, MO
    suppression of
    This term "menstruation" usually is used for defining the normal menstrual cycle.
    Can't we construde it as applicable to suppression of menstruation,.....
    NO we cannot construe it! The code is for a disorder of menstruation and other abnormal bleeding..... This must be documented by the physician, and the meaning is clear in the ICD-9 book. For an individual to express the desire to supress the menstral cycle is not abnormal nor is it a disorder. There are birth control methods on the market currently that will supress mentruation for 4 months or more at a time, so are we to code these ladies as having a disorder as well?? If we are to apply your logic then the answer is yes, but this too would be wrong. The senario presented in the original post is no different than a young woman electing one of these methods of contraception.

    Debra A. Mitchell, MSPH, CPC-H

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