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Menses suppression in CP female

  1. Default Menses suppression in CP female
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    Does anyone know which ICD9 code to use when depo provera is being used to suppress menses in a wheelchair bound teenager with cerebral palsy? Any assistance would be greatly appreciated. Donna

  2. #2
    V25.3 - Menstrual Extraction (regulation)
    V25.02 - Initiation of other contraceptive measures
    V25.9 - Unspecified contraceptive management

    I'd go with one of those...

  3. Default
    ICD 9 gives suppression of menstruation on to 626.8. I feel this holds good as for the reason for Suppression- therapeutic, induction, or any other reason not mentioned.
    here it is for threraputic purpose of suppression for an adolescent CP; meaning, creating a disorder.
    I think with this code and a secondary code for CP, along with physician report indicating why it is suppressed would go well.
    Menstrual Regulation is evacuating the uterus for persons who have a short period of amenorrhea in early pregnancy.- a kind of an abortion procedure
    By definition and stricly speaking, Menstrual regulation" (MR) or "menstrual extraction" (ME) are synonyms for an abortion procedure that is especially suited to circumventing the abortion laws of developing countries, because the abortions are performed so early that the "evidence" which results is either destroyed during the procedure or easily disposed of.
    So it is not for suppressing the menstruation .

    Secondly, it is not for "contraception" directly the supressing is undertaken for this girl; it for relieving her with all the ordeals she has to undergo with the menstrual process with the condition of CP though it could be one reason though. I fear whether we can admittedly and openly give this "contraception'' as the primary focus for suppressing or inducing amennorrhoeic status in her.

    Does this explanation make some sense?

  4. Default RE: ICD/Depo (contraceptive)for supression of menses/CP
    I'll assign the following:

    If initial visit:
    V25.02+343.9 + V46.3

    If subsequent f/up visit
    V25.49+343.9 + V46.3
    Initial depo- v25.02 PDX
    f/u depo-v25.49 PDX
    wheelchair dependence= V46.3 (coded to reflect the disabilty/necessitated depo contraceptive)

    The Coding Clinic Third Quarter, 1997 says to assign code V25.02 (encounter for contraceptive management, initiation of other contraceptive measures) for the initial Depo-provera injection and code V25.49 (contraceptive management, other method) for subsequent follow-up visits.
    I'd NOT agree with 626.8 bcoz it is "NOT iatrogenic( depo-induced)".The intent of depo is "to supress the menses". The pt is NOT with ANY "suppression of menses complaint".

    Last edited by msrd_081002; 12-16-2010 at 06:43 AM.

  5. #5
    I agree with msrd_081002. I wouldn't have selected a diagnosis from the disease/injury sections, because the patient wasn't being seen to treat a problematic or malfunctioning uterus/menstruation cycle. This seems to fit more with a V-code, according to ICD-9 conventions. The medication is primarily a contraceptive, even if it's not being used to prevent pregnancy, and the patient, who is otherwise asymptomatic (in regards to her reproductive system), is encountering health services for elective treatment using the drug.

    I did struggle with this one - I was really leaning towards procreative management as well, but that seemed a little too focused on fertility to really fit. I ended up deciding that the patient is undergoing management of a contraceptive, regardless of what the contraceptive's overall purpose is.

  6. Default
    Every one has the right to have their own views. But what our coding manual narrates to us is the most important.

    It seems as “Suppression of “Menstruation Vs “suppressed Menstruation”:

    A failure of menstruation to occur when expected, as in amenorrhea, or menstruation that is suppressed, as with Gn Rit agonists ,which is called suppression of menses.
    Indegeous(invivo hormonal status) suppressed menstruation- what happens ?-when FSH and LH are suppressed, the chances of ovulation and therefore ... ovulation suppression
    The act of “Suppression of” menstruation can be beneficial in prevention or treatment of several medical conditions. The mechanism involves a reduction in the volume and frequency of uterine bleeding or a reduction in normal cyclic hormonal fluctuations.. We are dealing with “reduction in normal cycle hormonal fluctuation in our ’ case study’.
    So,OUR ICD code MANUAL STATEMENT is correct in stating the word “ Suppression of “ ,(not specific as “Suppressed state” as you interpret), which holds good for coding purpose. By the way, the term suppression of menstruation is in vogue by the obgyn practice for the “of” rather than “-pressed”.
    Thank you and no more discussion from my side on this . Bye
    Last edited by preserene; 12-16-2010 at 10:35 AM.

  7. #7
    My ICD-9 has a note under 626.8 that says "Other specified irregular menstruation". I wouldn't feel comfortable assigning a code from the subsection "Disorders of menstruation and other abnormal bleeding from female genital tract", in the absence of any such disorder. So, I'll agree to disagree with you on this one.

  8. #8
    Stuart, Florida
    I agree with msrd_081002, 100%. The patient's suppression of menses is forced, by way of depo-provera. It is not a naturally occuring disorder with the patient. It is purposely being done for patient comfort, well being, and due to concerns related to hygiene and problems coping. Menses can be difficult to manage in some adolescent girls with CP. Difficulties may arise in managing hygiene by the adolescent or family. Dysphoria/irritability/cramping or heavy periods may occur, as in any adolescent population, and some girls experience exacerbation of their seizure disorder with the menstrual cycle.

    If the suppression of menses were naturally occuring in this patient, 626.8 could be considered, but that is not the case. However, secondary amenorrhea is where an established menstruation has ceased - for three months in a woman with a history of regular cyclic bleeding, or six months in a woman with a history of irregular periods. Secondary amenorrhea, 626.0, does encompass the drug-induced suppression of menstruation, but this is AFTER the depo-provera is shown to have worked in suppression for 3-6 months, depending on the situation.

    For more information please see:
    Vanessa Mier, CPC

  9. Default
    Now I am sorry I have to come back.
    Your argument not to place the” suppression of menstruation” in the diagnosis code 626.8 is baseless. It is THE DOCUMENTED DIAGNOSIS AND THE TERMINOLOGY IN THIS CASE.
    Well, in my OBGYN career of 30yrs , me or any OBGYN giving a diagnosis of “suppression of” menstruation as a diseased condition, though it makes sense to include suppressed condition too. It is only documented as a necessity or perfoming as an act of SUPPRESSION OF MENSTRUATION. That is the way it is placed in the ICD-9 code too after careful thoughts and the panel acceptance with many thoughts from AMA . The act of producing a condition of “suppression of menstruation” itself SUFFICE to report it with 626.8, irrespective of the induced condition in otherwise normally menstruating who needs the medical intervention .
    You kindly read my previous post and if you do not understand it the way it should be, take as the manual says. If not agreeing, clarify with any OBGYN PHYSICIAN /CONSULTANT.
    Then diagnosis of suppression of Menstruation is given by the physician when the necessity for suppression sets in, not by you and me.
    The natural suppression by bodily hormones usually goes with the term “delayed period”, if it does not meet the secondary amennorrhea criteria which is defined as the absence of mensus for 6 months (or greater than three times the previous cycle intervals) in a woman who had been menstruating before. AND FOR YOUR KIND INFORMATION, IT DOES NOT GO WITH THE TERM “SUPPRESSTION OF MENSTRUATION” diagnosis by and large by the physicians and their documentation
    The term Suppression Of Menstruation is universally and commonly accepted and used in practice by the OBGYN exclusively for creating/producing a condition of suppression of already menstruating women for some reason and that is how the AMA has placed the term “suppression of “ menstruation into that category though it is an induced status,(with no other place being given) whether it is a mis- norm or misplaced, as per your concept, to be there ; it is to be accepted for coding purpose too in such scenario.

    Hi, there, don't extend to say I AM STUCK with the word. Yes as a medical professionalist, I have to be detailed so, because it is a human life we are dealing with and we cannot slack or afford to have any morbidity or mortality on any account.That is MEDICINE AND THE HEALTH PROFESSION. So also I wish to carry on with the payment system with minor details being given importance

  10. #10
    Baseless? No. First of all, the exact terminology used in the note is not available. If you'd refer to the original post, it is paraphrased. Only debrowne knows what the note says. The only diagnosis documented is CP. The patient is not receiving treatment for menses which are currently suppressed, as would be indicated by assigning a diagnosis of "suppression of menstruation". They fit in perfectly with the primary circumstances for the use of V-codes, located in Section 1, Chapter 18 of the ICD-9 coding conventions. Of particular significance is the note on #2: "A diagnosis/symptom code should be used whenever a current, acute diagnosis is being treated, or a sign or symptom is being studied."
    To assign a diagnosis/symptom code is to state that the patient is currently afflicted with that condition, not that they are in the office to have that condition established.

    I'm not questioning your 30 years experience; you've been coding longer than I've been alive. You and I may have a fundamental disagreement on the symantics of this issue, but I'm sticking to my guns on this one. It's perfectly possible that I'm dead wrong about this, but I feel strongly that this particular situation warrants the assignment of a V-Code, based on my understanding of ICD-9 guidelines.
    Last edited by btadlock1; 12-16-2010 at 03:53 PM.

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