Chapter 19 Female Reproductive System International Classification of Diseases Tenth Revision Procedure Coding System (ICD-10-PCS): An Applied Approach 2012 Edition Chapter 19 Female Reproductive System

Functions of the Reproductive Systems Both male and female Produce offspring to maintain the species Female reproductive system – Body System U

Functions of the Female Reproductive System Produce gametes cell -Eggs or ova Transport and sustain these cells Nurture developing offspring Produce hormones Ovary is the primary reproductive organ

Organization of the Female Reproductive System Ovaries Uterine supporting structures Fallopian tubes Uterus Endometrium Cervix Cul-de-sac Vagina Clitoris Hymen Vestibular glands Vulva Ova

Ovary Ovary -Small solid structure on either side of the uterus -Held in place by peritoneal ligaments -Produce ova in an ovarian follicle -Egg is released and follicle enlarges and becomes a corpus luteum If egg is fertilized corpus luteum continues to create hormones

Fertilization Released egg caught by fimbriae at the end of fallopian tube Transported towards the uterus If fertilized – classified as Products of Conception by ICD-10-PCS Fertilized egg implants in the endometrium of the uterus and develops into a fetus -See Chapter 20

Uterus Uterus -Muscular structure in pelvic cavity -Held in place by the uterine supporting structures Broad ligaments (paired) Uterosacral ligaments (paired) Posterior ligament (single) Anterior ligament (single) Round ligament (paired)

Uterus (continued) Cul-de-sac – blind pouch also known as rectouterine pouch Vestibular glands -Skene’s glands -Bartholin glands Endometrium – inner lining of the uterus See Figure 19.1

Vulva External genitalia -Mons pubis -Labia majora -Labia minora -Clitoris -Urethral and vaginal openings -Vestibular glands -Hymen -See Figure 19.2

Common Root Operations Sterilization -Occlusion – using sutures, clips or rings -Destruction – burning the fallopian tubes Division of the tubular body part prior to closing is an integral part of the procedure -Resection – complete removal of the fallopian tubes Reversal of a tubal ligation – tubotubal anastomoses - Repair

Colporrhaphy Colporrhaphy – repair of ruptured vagina -Anterior – front of the vagina, involvement with bladder -Posterior – back of the vagina, involvement with rectum -Either may include fistulas between organs -Repair is the root operation -Supplement if mesh is used

Vaginal Procedures Colpocleisis – secure vaginal walls together internally with obliteration of the vaginal opening -Occlusion is the root operation if totally closed Colpopexy and/or ureteropexy-fixation and maintain vaginal introitus -Reposition

Cervical Conization Cervical conization – cold knife or cone biopsy – used to treat early stages of cervical cancer -Small cone-shaped sample is removed from the cervix and examined under a microscope -Biopsy can be the treatment if all is removed -Can also be performed using loop electrode-LEEP -Excision is the root operation X for diagnostic in the qualifier if this is a biopsy

Common Procedures Cervical cerclage – strong suture or wire around the cervix making the opening smaller and stronger -Restriction is the root operation -Coded in Female Reproductive as performed on the pregnant female Endometrial ablation via thermal or cryoablation -Destruction is the root operation Endometrial biopsy – Extraction with X for the qualifier

Other Procedures Marsupialization of the Bartholin’s gland cyst -Drainage of cyst -Excision of sac -Both procedures can be coded if performed Transplantation of the ovary See Table 19.1

Body Part Values-Hysterectomy Total hysterectomy = removal of the uterus and cervix Subtotal hysterectomy = only the uterus is removed, cervix left intact Resection is the root operation as all of the body part is removed TAH – BSO requires 4 codes - Cervix - Bilateral Fallopian tubes - Uterus - Bilateral Ovaries

Bilateral Body Parts Body part values for individual ovaries and fallopian tubes as well as bilateral See Coding guideline B4.3 Combined body part values in some root operations that involve devices or inspection -Uterus and cervix -Vagina and cul de sac See Table 19.2

Approaches F – Via natural of artificial opening with percutaneous endoscopic assistance -Laparoscopic ports and visualizing instruments through the skin to assist with resection, vaginally -Only used in the Female Reproductive System -Only used with the Resection root operation -Only for body parts ovaries, fallopian tubes and uterus All seven approaches are used, See Table 19.3

Devices G – Intraluminal Device –Pessary H – Contraceptive Device -see Figure 1.7 -Appliance of varied form, introduced into the vagina to support the uterus or correct displacement or prolapse -Fitted by provider H – Contraceptive Device -Usually means IUD See Table 19.4

Qualifiers Transplantation of ovary – qualifiers for the source of the transplant -Allogeneic -Syngeneic -Zooplastic X - Diagnostic Z – No Qualifier See Table 19.5