(text on screen): Fertility Authority. Your Most Trusted Source Ask the Experts How are fibroids diagnosed and treated? Jenna McCarthy, South Florida Institute for Reproductive Medicine: Most of the time, fibroids are initially diagnosed on ultrasound. And then they can be definitively diagnosed from a fertility standpoint by either a saline infusion sonogram, or an HSG. If the fibroid is well away from the cavity, and it’s not changing the shape of the cavity at all, and it’s not causing you any other symptoms, there’s no reason you need to have it taken out. So, s typically will recommend that you have the fibroid taken out if it’s changing the shape of the cavity,.
Or if it’s causing some of the other symptoms. Fibroids are typically removed one of two ways. You can either have them removed by having a surgery, either laparoscopically or an open surgery where they make an incision in the belly, and have the fibroids removed. Alternatively, fibroids that are completely within the cavity can sometimes be removed vaginally. It depends on where the fibroid is. So, let’s start with a large fibroid that’s large enough that it’s changing the shape of the cavity. That type of fibroid might be removed laparoscopically, which is a couple of small incisions on the belly, nothing big. The procedure is usually performed as an outpatient procedure, which means that you can go home the same day,.
Sleep in your own bed, take your pain medicines yourself, instead of having to be in the . The healing time from that is typically two to six weeks, depending on the woman and how active she is. And then we usually ask you to wait three months before trying to get pregnant. Some s will err on the side of caution and say as much as six months before trying to get pregnant. And then, typically, if the fibroid that was removed was large enough that we actually went all the way through the wall of the uterus to take it out, we’ll recommend a csection for delivery, to help prevent the chance that the scar that’s left in its place doesn’t pop open during labor. The other way to remove fibroids is hysteroscopically, or vaginally. Those are fibroids that are completely within the cavity.
So, basically, they can put a little camera inside the uterus and look around; you can see the whole fibroid. Those, the recovery time is even faster. The surgery itself, again, is outpatient. You go home the same day. The pain is much, much less associated with it. Most women are back to work within a week to two weeks. Some women don’t even need that much time. And we usually don’t ask you to wait more than one normal period before you try and get pregnant. And neither of the two surgeries make it so that you can or cannot have fertility treatments. Some gynecologists are extremely skilled at removing fibroids. Other gynecologists prefer to refer those patients to either a reproductive endocrinologist or a minimally invasive surgeon.
The advantage to doing that is most REs and minimally invasive surgeons are trained in doing laparoscopic myomectomies. The difference between a laparoscopic myomectomy and an abdominal myomectomy is the recovery time. With a laparoscopic, most women, really, are up and around and doing for themselves in about two weeks. It may be six weeks before they feel 100 percent, but they’re usually at 80 percent or better by two weeks. With an abdominal myomectomy, you’ve actually gone through the big muscles of the abdominal wall, so, just like a csection or any other major abdominal surgery, it takes you that full six to eight weeks to feel like yourself again. 0:03:12.000,0:03:14.000 (text on screen): Fertility Authority. Your Most Trusted Source.
ICD10 Coding Annual Physical with Chronic Conditions
Laureen: Q: Annual Physical â€œICD10 question, if a patient is in for an annual physical and has chronic conditions like diabetes mellitus or hypertension, would you use Z00.01?â€� Alicia: Chandra knows this one. Chandra: A: Z00.01 is annual preventive or adult preventive examination with abnormal findings. As we talked about earlier, abnormal findings means we found something during that exam that we didn’t already know that the patient had. Chronic conditions would be things we already knew the patient had. The thing that I go back to with that and then determining whether we knew it ahead.
Of time, look at some of your documentation guidelines. If you really want to think about it, I’m going to cite inpatient for a minute, but if you look at your Present on Admission Guidelines, they tell you any chronic condition that patient had before they were admitted are considered present on admission. It’s kind of the same thought, they come in and do a preventive exam, we knew they had hypertension, we knew they had diabetes, we knew they had whatever. Even if we write them a script to refill those meds, it’s not that we found something abnormal during this exam. It’s simply that we gave them a script for their chronic conditions.
Laureen: Very good. Alicia: If it is a new condition, they’ll document that they’ll be doing counseling on they’re sending them to the diabetes nurse and getting counseling on nutrition that this is a new finding butâ€¦ Chandra: And then in that case, then they also have to make sure that anytime they use the code that says they did a preventive with an abnormal finding they need an additional code to identify what that abnormal finding is. That’s typically where they’re going to be saying, â€œOh, we just found this abnormal lesion on the skin, we better do a biopsyâ€�.
Or â€œwe found a breast lumpâ€� or â€œwe found uterine fibroidsâ€� or â€œwe found this heart murmurâ€� and they’re going to be ordering additional workup, doing additional things for that in most situations.